李双齐 韩冬 丛庆学

[摘要] 目的 對普外手术治疗胆源性急性胰腺炎的疗效及安全性进行分析探讨。方法 经该院医学伦理委员会批准同意，便利选取2016年1月—2018年12月在该院接受治疗的102例胆源性急性胰腺炎患者作为研究对象，将其按照双盲法随机分为两组，观察组51例患者于发病3 d内行普外早期手术，对照组51例患者于发病4～8 d内行普外延期手术，对比两组术后24 h引流量、住院时间、治疗有效率、并发症发生率及病死率。结果 观察组住院时间短于对照组，术后24 h引流量少于对照组，APACHE II评分低于对照组，差异有统计学意义（t=6.903、12.774、5.388，P<0.05）。观察组治疗有效率为94.12%，显著高于对照组的86.27%，差异有统计学意义（χ2=13.902，P<0.05）。观察组并发症发生率为1.96%，明显低于对照组的21.57%，差异有统计学意义（χ2=17.221，P<0.05）。观察组病死率为0.00%，明显低于对照组的7.84%，差异有统计学意义（χ2=8.281，P<0.05）。结论 对胆源性急性胰腺炎患者积极实施早期手术，可有效缓解患者临床症状，提高治疗效果，降低并发症发生率及病死率，改善患者预后。

[关键词] 普外手术;胆源性急性胰腺炎;疗效;APACHE II评分;并发症;病死率

[中图分类号] R5          [文献标识码] A          [文章编号] 1674-0742（2020）06（a）-0040-03

Analysis of the Effect of General Surgery on Biliary Acute Pancreatitis

LI Shuang-qi1， HAN Dong2， CONG Qing-xue3

1.General Surgery 12 Ward，Daqing Longnan Hospital （Fifth Affiliated Hospital of Qiqihar Medical College）， Daqing， Heilongjiang Province， 163453 China; 2.Traumatic Hand Surgery，Daqing Longnan Hospital （Fifth Affiliated Hospital of Qiqihar Medical College）， Daqing， Heilongjiang Province， 163453 China; 3.Department of Magnetic Resonance Imaging，Daqing Longnan Hospital （Fifth Affiliated Hospital of Qiqihar Medical College Hospital）， Daqing， Heilongjiang Province， 163453 China

[Abstract] Objective To analyze the efficacy and safety of general surgery for biliary acute pancreatitis. Methods With the approval and approval of the Medical Ethics Committee of our hospital， convenient selection of 102 patients with biliary acute pancreatitis who were treated in the hospital from January 2016 to December 2018 were taken as the research objects， and they were randomly divided into two according to the double-blind method， observation group of 51 patients underwent early general surgery within 3 days of onset， control group of 51 patients underwent general extension surgery within 4-8 days of onset， compared 24 h postoperative drainage， hospital stay， treatment efficiency， complications incidence and mortality. Results The length of stay in the observation group was shorter than that in the control group， and the drainage volume was less than that in the control group at 24 hours after operation. The APACHE II score was lower than that in the control group ，the difference was statistically significant（t=6.903， 12.774， 5.388， P<0.05）. The effective rate of treatment in observation group was 94.12%， which was significantly higher than 86.27% in control group， the difference was statistically significant（χ2=13.902，P<0.05）. The incidence of complications in the observation group was 1.96%， which was significantly lower than the control group's 21.57%， the difference was statistically significant（χ2=17.221，P<0.05）. The mortality in the observation group was 0.00%， which was significantly lower than the 7.84% in the control group，and the difference was statistically significant（χ2=8.281，P<0.05）. Conclusion Actively performing early surgery on patients with biliary acute pancreatitis can effectively alleviate the clinical symptoms of patients， improve the treatment effect， reduce the incidence of complications and mortality， and improve the prognosis of patients. It is worthy of clinical application and promotion.

[Key words] General surgery; Biliary acute pancreatitis; Efficacy; APACHE II score; Complications; Mortality

胆源性急性胰腺炎为临床常见性急腹症，发病率为胰腺炎的30%～50%，一般由感染、发炎、结石等引起胰液外溢或胰管梗阻引起，临床症状主要有呕吐、发热、消化道出血、腹痛等，严重可出现大出血、休克、甚至死亡[1]。急性胰腺炎是及早进行手术，以控制胰腺炎症，还是在机体状况稳定之后再进行手术治疗，临床上目前尚存在一定争议。大量临床研究显示，对于急性胰腺炎患者行保守治疗，效果不太理想，且容易延误最佳治疗时机。对于手术治疗而言，不同手术方式及不同手术时机对治疗效果有着不同的影响[2]。为进一步对胆源性急性胰腺炎的手术时机进行分析探讨，笔者对2016年1月—2018年12月在该院接受治疗的102例患者進行对照研究，现报道如下。

1  资料与……