160例重症急性胰腺炎的回顾性临床研究
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摘要
目的 为了解近年SAP发病病因的变化、总结病情判断及相关治疗的经验。
方法 收集我院1980年1月至2000年12月间，住院治疗的SAP共160例。将SAP病因分为胆源性、酒精性及其它，对3种病因的频率进行统计分析。用S-B评分系统对所收集的病例评分值与预后进行相关性分析，并与APACHEII评分系统进行对比，评价S-B评分系统对病情严重度的判断价值。将所有病例按病人是否在发病后10天内施行手术治疗分为手术治疗组（n=79）与非手术治疗组（n=81），收集两组的平均病程、并发症发生率及死亡率进行统计分析。将1997年1月以后的病例按是否使用了生长抑素分为使用生长抑素治疗组（n=26）与未使用生长抑素组（n=40），收集两组平均病程、并发症发生率及死亡率进行统计分析。
结果 胆源性107例（66.9%），酒精性22例（13.8%），其他31例（19.3%）。随着S-B评分值的升高，病人的平均病程，并发症发生率及死亡率均显著升高（P<0.01），相对于APACHEII评分系统，S-B评分系统能更好地反映疾病的病程时间的变化情况（P<0.05）。手术组与非手术组S-B评分分别为11.90±4.02和11.35±4.50（P>0.05），两组病情严重度无显著性差异，非手术组其平均病程及死亡率显著低于手术组（P值分别为<0.01及<0.05），而并发症发生率二者无明显差异（P>0.05）。是否使用生长抑素治疗的两组中，S-B评分分别为12.58±3.87和11.85±5.29（P>0.05），二者病情严重度无明显差异，其平均病程、并发症发生率及死亡率也无明显差异（P>0.05）。
结论 一、在我国，SAP的发病原因以胆源性居多，近年随着ERCP检查的广泛开展，应注意其对SAP发病的影响。
二、 S-B评分系统可以较好地反映SAP的病情严重度，可以用来对SAP的严重程度及变化情况进行动态评估，对SAP的预后判断也有一定价值。
三、在SAP的早期，应采取非手术治疗为主，在非手术治疗的同时，应严密观察病情变化，若发现手术指征，应及时手术。
胰腺包膜切开减压加腹腔持续冲洗引流术，是SAP早期手术治疗的一个较好手术方式。
四、当SAP病人已产生了SIRS时，使用生长抑素，对病人的平均病程、并发症发生率及死亡率并无显著影响。
Objective: To explore the changes of the etiology of SAP, summarize the experiences of the evaluation of patients' condition and the treatment of SAP.
Methods: One hundred and sixty cases of SAP were studied. The reasons for SAP were divided into biliary, alcoholic and others. The correlation between S-B scoring system and prognosis was analyzed. In order to evaluate the S-B scoring system's value of the assessment of the severity of SAP, comparison was made between S-B scoring system and APACHEII scoring system. Comparison was made between 79 cases who were treated by early operation and 81 cases who were treated non-operatively in the mean hospital stay, the incidence of complication and the mortality. In order to observe the curative effect with somatostain, comparison was made between 20 cases who were treated with somatostain and 40 cases who were treated without somatostain from 1997 to 2000 in the mean hospital stay, the incidences of complication and the mortality .
Results: It was found that 107 cases (66.9%) of the SAP was caused by biliary reasons, 22 (13.8%) by alcoholic reasons and 31(19.3%) by other reasons. With the rising of the value of the S-B score, the mean hospital stay, the complication and the mortality ascend too. S-B scoring system can reflect the variation of the mean hospital stay better than APACHEII scoring system. In control study between operative and non-operative treatments, the score of the S-B were 11.90±4.02 and 11.35±4.50（P>0.05），the severity of SAP in two groups have no differences. The mean hospital stay and the mortality rate in non-operative group were fewer than operative group, while the complications in two groups have no differences. When compared between the patients
treated with somatostain and without somatostain, the score of the S-B were 12.58±3.87 and 11.35±4.50（P>0.05）. The severity of SAP ,as well as the mean hospital stay, complication and the mortality have no differences（P>0.05）.
Conclusions:
1、In our country, the main etiology factors of SAP was biliary. Because of ERCP's being carried out widely nowadays，we should pay attention to the influence of ERCP .
2、The S-B scoring system can reflect the severity of SAP, It could be applied to evaluate the severity of SAP and to determine the prognosis.
3、In the earlier stage of SAP, the treatment should be non-operation, meanwhile, the patient should observed carefully, as soon as the indications of operation were found, an operation should be performed in time.
The open decompression of pancreatic envelope with lasting abdominal flushing and drainage may be beneficial in the earlier stage of SAP.
4、When patients had occured SIRS, it could have no affection in the mean hospital stay, the complication and the mortality if they are treated by somatostain only.
方法 收集我院1980年1月至2000年12月间，住院治疗的SAP共160例。将SAP病因分为胆源性、酒精性及其它，对3种病因的频率进行统计分析。用S-B评分系统对所收集的病例评分值与预后进行相关性分析，并与APACHEII评分系统进行对比，评价S-B评分系统对病情严重度的判断价值。将所有病例按病人是否在发病后10天内施行手术治疗分为手术治疗组（n=79）与非手术治疗组（n=81），收集两组的平均病程、并发症发生率及死亡率进行统计分析。将1997年1月以后的病例按是否使用了生长抑素分为使用生长抑素治疗组（n=26）与未使用生长抑素组（n=40），收集两组平均病程、并发症发生率及死亡率进行统计分析。
结果 胆源性107例（66.9%），酒精性22例（13.8%），其他31例（19.3%）。随着S-B评分值的升高，病人的平均病程，并发症发生率及死亡率均显著升高（P<0.01），相对于APACHEII评分系统，S-B评分系统能更好地反映疾病的病程时间的变化情况（P<0.05）。手术组与非手术组S-B评分分别为11.90±4.02和11.35±4.50（P>0.05），两组病情严重度无显著性差异，非手术组其平均病程及死亡率显著低于手术组（P值分别为<0.01及<0.05），而并发症发生率二者无明显差异（P>0.05）。是否使用生长抑素治疗的两组中，S-B评分分别为12.58±3.87和11.85±5.29（P>0.05），二者病情严重度无明显差异，其平均病程、并发症发生率及死亡率也无明显差异（P>0.05）。
结论 一、在我国，SAP的发病原因以胆源性居多，近年随着ERCP检查的广泛开展，应注意其对SAP发病的影响。
二、 S-B评分系统可以较好地反映SAP的病情严重度，可以用来对SAP的严重程度及变化情况进行动态评估，对SAP的预后判断也有一定价值。
三、在SAP的早期，应采取非手术治疗为主，在非手术治疗的同时，应严密观察病情变化，若发现手术指征，应及时手术。
胰腺包膜切开减压加腹腔持续冲洗引流术，是SAP早期手术治疗的一个较好手术方式。
四、当SAP病人已产生了SIRS时，使用生长抑素，对病人的平均病程、并发症发生率及死亡率并无显著影响。
Objective: To explore the changes of the etiology of SAP, summarize the experiences of the evaluation of patients' condition and the treatment of SAP.
Methods: One hundred and sixty cases of SAP were studied. The reasons for SAP were divided into biliary, alcoholic and others. The correlation between S-B scoring system and prognosis was analyzed. In order to evaluate the S-B scoring system's value of the assessment of the severity of SAP, comparison was made between S-B scoring system and APACHEII scoring system. Comparison was made between 79 cases who were treated by early operation and 81 cases who were treated non-operatively in the mean hospital stay, the incidence of complication and the mortality. In order to observe the curative effect with somatostain, comparison was made between 20 cases who were treated with somatostain and 40 cases who were treated without somatostain from 1997 to 2000 in the mean hospital stay, the incidences of complication and the mortality .
Results: It was found that 107 cases (66.9%) of the SAP was caused by biliary reasons, 22 (13.8%) by alcoholic reasons and 31(19.3%) by other reasons. With the rising of the value of the S-B score, the mean hospital stay, the complication and the mortality ascend too. S-B scoring system can reflect the variation of the mean hospital stay better than APACHEII scoring system. In control study between operative and non-operative treatments, the score of the S-B were 11.90±4.02 and 11.35±4.50（P>0.05），the severity of SAP in two groups have no differences. The mean hospital stay and the mortality rate in non-operative group were fewer than operative group, while the complications in two groups have no differences. When compared between the patients
treated with somatostain and without somatostain, the score of the S-B were 12.58±3.87 and 11.35±4.50（P>0.05）. The severity of SAP ,as well as the mean hospital stay, complication and the mortality have no differences（P>0.05）.
Conclusions:
1、In our country, the main etiology factors of SAP was biliary. Because of ERCP's being carried out widely nowadays，we should pay attention to the influence of ERCP .
2、The S-B scoring system can reflect the severity of SAP, It could be applied to evaluate the severity of SAP and to determine the prognosis.
3、In the earlier stage of SAP, the treatment should be non-operation, meanwhile, the patient should observed carefully, as soon as the indications of operation were found, an operation should be performed in time.
The open decompression of pancreatic envelope with lasting abdominal flushing and drainage may be beneficial in the earlier stage of SAP.
4、When patients had occured SIRS, it could have no affection in the mean hospital stay, the complication and the mortality if they are treated by somatostain only.
引文
1、 中华医学会外科学会胰腺学组. 急性胰腺炎的临床诊断及分级标准. 中华外科杂志，1997，35(12)：773-775
2、 沈魁，钟守先，张圣道. 胰腺外科. 人民卫生出版社，2000年4月第一版
3、 Agatwal N，Pitchumani CS，et al. Assess men of sevetity in acute Pancreatitis. Am J, Gastroenterol, 1991, 86:1385
4、 Rau B, Steinbach G, Baumgart K, et al. Serum amyloid A versus C- reactive protein in acute pancreatitis: clinical value of an alternative acute-phase reactant. Crit Care Med 2000 Mar;28(3):736-42
5、 Richter A, Nebe T, Wendl K, et al. HLA-DR expression in acute pancreas- titis. Eur J Surg 1999 Oct;165(10):947-51
6、 Inagaki T, Hoshino M, Hayahawa T, et al. Interleukin-6 is a useful maker for early perdiction of the severity of acute pancreatitis. Pancreas, 1997, 14: 1-8
7、 Pezzilli R, Billi P, Miniero R, et al. Serum Interleukin-6, Interleukin-8 and ?2-microglobulin in early assessment of severity of acute pancreatitis. Dig Dis Sci,1995, 40: 2341-2348
8、 Ranson JHC, Rifkind KM, et al. Progonstic and the role of operation management in acute pancreatitis. Surg Gynecol Obstet, 1974; 139(1): 69
9、 Knaus WA, Draper EA, et al. APACHEII: a severity of disease classifica- tion system. Crit Care Med, 1985; 13(10): 818
10、林进令，曾健，陆云飞，等. 急性胰腺炎诊治方法变迁与预后的关系：附265例临床分析. 广西医学，2000.02.15; 22(1): 24-26
11、张继红，古立诚，戴丽华，等. 重症急性胰腺炎的临床特点及治疗对策中国普通外科杂志，2000.05.30; 9(3): 195-198
12、金莜泰，邵卫中，袁祖荣，等. 25年381例重症急性胰腺炎治疗经验.
肝胆胰外科杂志，1999，11（2）：63-65
13、 姚榛祥. 重症胰腺炎现代治疗的认识. 中华肝胆外科杂志，1999；5(2)：76
14、袁祖荣，陈尔真，瞿洪平，等. 重症急性胰腺炎早期手术指征的探讨. 中华实用外科杂志，1999；19（9）：538-539
15、周总光，程中，舒晔. 胰腺微循环障碍与急性胰腺炎. 中华实用外科杂志，1999；19（9）：522-525
16、汪训实, 金炜东, 张兆林,等. 重症急性胰腺炎的手术时机和手术方法选择. 中国普通外科杂志, 2000; 9(3): 206-209
17、陈建中，戴植本. 实验鼠重症急性胰腺炎时奥曲肽对细菌易位影响的质粒标记研究. 中华普通外科杂志, 1999; 14(2): 97-99
18、刘文卓，罗开元，王明春，等. 生长抑素治疗重症急性胰腺炎的疗效观察. 临床外科杂志，1998; 6(4): 203-204
19、倪俊，黄发彬. 重症急性胰腺炎患者的生长抑素治疗. 华北煤炭医学院学报 2001；3(2): 150-151
20、冯鹏才，吴炜，王力俊，等. 运用生长抑素非手术治疗重症急性胰腺炎. 青海医学院学报，2000；21(3): 21-22
21、张群华，蔡端，倪泉兴，等. 生长抑素和生长激素联合应用治疗重症急性胰腺炎. 中华实用外科杂志, 1999; 19(9): 535-537
22、Balteslcard L, Unnebery K, Mjaaland M, et al. Growth hormone and insulinlinke growth factory - 1 promote intestinal uptake and hepatic release of glutamine in sepsis. Ann Surg, 1998; 228(1):131
23、张群华，蔡端，倪泉兴，等. 生长抑素和生长激素对急性坏死性胰腺炎肝损伤的保护作用. 中华医学杂志, 1998; 78(8): 621
24、李维勤, 黎介寿, 顾军, 等. 重组人生长激素治疗腹腔感染后低白蛋白血症的实验与临床研究. 中华医学杂志, 1998; 78(6): 413
2、 沈魁，钟守先，张圣道. 胰腺外科. 人民卫生出版社，2000年4月第一版
3、 Agatwal N，Pitchumani CS，et al. Assess men of sevetity in acute Pancreatitis. Am J, Gastroenterol, 1991, 86:1385
4、 Rau B, Steinbach G, Baumgart K, et al. Serum amyloid A versus C- reactive protein in acute pancreatitis: clinical value of an alternative acute-phase reactant. Crit Care Med 2000 Mar;28(3):736-42
5、 Richter A, Nebe T, Wendl K, et al. HLA-DR expression in acute pancreas- titis. Eur J Surg 1999 Oct;165(10):947-51
6、 Inagaki T, Hoshino M, Hayahawa T, et al. Interleukin-6 is a useful maker for early perdiction of the severity of acute pancreatitis. Pancreas, 1997, 14: 1-8
7、 Pezzilli R, Billi P, Miniero R, et al. Serum Interleukin-6, Interleukin-8 and ?2-microglobulin in early assessment of severity of acute pancreatitis. Dig Dis Sci,1995, 40: 2341-2348
8、 Ranson JHC, Rifkind KM, et al. Progonstic and the role of operation management in acute pancreatitis. Surg Gynecol Obstet, 1974; 139(1): 69
9、 Knaus WA, Draper EA, et al. APACHEII: a severity of disease classifica- tion system. Crit Care Med, 1985; 13(10): 818
10、林进令，曾健，陆云飞，等. 急性胰腺炎诊治方法变迁与预后的关系：附265例临床分析. 广西医学，2000.02.15; 22(1): 24-26
11、张继红，古立诚，戴丽华，等. 重症急性胰腺炎的临床特点及治疗对策中国普通外科杂志，2000.05.30; 9(3): 195-198
12、金莜泰，邵卫中，袁祖荣，等. 25年381例重症急性胰腺炎治疗经验.
肝胆胰外科杂志，1999，11（2）：63-65
13、 姚榛祥. 重症胰腺炎现代治疗的认识. 中华肝胆外科杂志，1999；5(2)：76
14、袁祖荣，陈尔真，瞿洪平，等. 重症急性胰腺炎早期手术指征的探讨. 中华实用外科杂志，1999；19（9）：538-539
15、周总光，程中，舒晔. 胰腺微循环障碍与急性胰腺炎. 中华实用外科杂志，1999；19（9）：522-525
16、汪训实, 金炜东, 张兆林,等. 重症急性胰腺炎的手术时机和手术方法选择. 中国普通外科杂志, 2000; 9(3): 206-209
17、陈建中，戴植本. 实验鼠重症急性胰腺炎时奥曲肽对细菌易位影响的质粒标记研究. 中华普通外科杂志, 1999; 14(2): 97-99
18、刘文卓，罗开元，王明春，等. 生长抑素治疗重症急性胰腺炎的疗效观察. 临床外科杂志，1998; 6(4): 203-204
19、倪俊，黄发彬. 重症急性胰腺炎患者的生长抑素治疗. 华北煤炭医学院学报 2001；3(2): 150-151
20、冯鹏才，吴炜，王力俊，等. 运用生长抑素非手术治疗重症急性胰腺炎. 青海医学院学报，2000；21(3): 21-22
21、张群华，蔡端，倪泉兴，等. 生长抑素和生长激素联合应用治疗重症急性胰腺炎. 中华实用外科杂志, 1999; 19(9): 535-537
22、Balteslcard L, Unnebery K, Mjaaland M, et al. Growth hormone and insulinlinke growth factory - 1 promote intestinal uptake and hepatic release of glutamine in sepsis. Ann Surg, 1998; 228(1):131
23、张群华，蔡端，倪泉兴，等. 生长抑素和生长激素对急性坏死性胰腺炎肝损伤的保护作用. 中华医学杂志, 1998; 78(8): 621
24、李维勤, 黎介寿, 顾军, 等. 重组人生长激素治疗腹腔感染后低白蛋白血症的实验与临床研究. 中华医学杂志, 1998; 78(6): 413
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