重症急性胆源性胰腺炎手术时机的探讨
|
摘要
目的:探讨重症急性胆源性胰腺炎(SABP)手术时机对预后的影响,并分析其死亡的高危因素。方法:对78例SABP患者的临床资料进行回顾性分析,根据手术时间,分为早期手术(2周内)和延期手术(2周后);并根据胆道有无梗阻将患者分为非梗阻型和梗阻型,对两组患者在不同手术时间的治愈率、并发症的发生率及病死率进行比较分析,并对死亡的高危因素采用Logistic回归分析。结果:非梗阻型:早期手术治疗12例,治愈7例,并发症9例,死亡5例;延期手术42例,治愈38例,并发症9例,死亡4例。梗阻型:早期手术治疗10例,治愈7例,并发症6例,死亡3例;延期手术14例,治愈12例,并发症7例,死亡2例。经统计学分析,重症非梗阻型早期与延期手术的治愈率、并发症的发生率、病死率差异有统计学意义( P < 0. 05)。多因素分析显示MODS(OR=15.35 P<0.05),APACHEⅡ评分(OR=2.41 P<0.05)是影响SABP预后的独立危险因素。结论:重症急性胆源性胰腺炎的手术时机应依据个体病情而定,非梗阻型SABP早期手术风险较高,适宜非手术治疗。选择合理的手术时机并对高危因素进行早期预防和及时处理是降低SABP病死率的关键。
Objective: To investigate the affecting of the operation opportunity of severe acute biliary pancreatitis (SABP) about prognosis and to study the risk factor affecting the mortality of this and to reduce postoperative mortality. Methods: The clinical data of 78 patients with SABP admitted to the department of surgery of our hospital were retrospectively analyzed. The operation opportunity, the cure rate, the relapse rate, the mortality rate and the risk factoring the mortality were analyzed in 78 patients with the SABP . Results: Based on the analysis of the treatment methods and its outcome , SABP should be divided into two types according to the duct obstruction and the timing of surgical .(1) There are 12 patients of non-obstructive mild type SABP received surgical operations with in 2 weeks after the onset, 7 cases were cured, 9 cases had complications, 5 cases died; of 42 patients received surgical operations after 2 weeks from onset, 38 cases were cured, 9 cases had complications, 4 cases died; (2) There are 10 patients of obstructive mild type SABP received surgical operations with in 2 weeks after the onset, 7 cases were cured, 6 cases had complications, 3 cases died; of 14 patients received surgical operations after 2 weeks from onset, 12 cases were cured, 7 cases had complications, 2 cases died. the incidence of complications and mortality had significantly difference in different operation opportunity of non- obstructive group. Multiple factor Logistic regression analysis indicated that the MODS(OR=15.35, P<0.05), APACHEⅡscore (OR=2.41, P<0.05) were the independent risk factor affecting the prognosis of SABP. Conclusion: The principle of individual operation is importance of SABP. The operation opportunity is one of the most important factors impact the mortality of SABP . The non-obstructive type patients should be cure of better in conservative way. Therefore, to make sure a reasonable operation opportunity and early prevention and correct management on the risk factors play critical roles in reducing the mortality of SABP.
Objective: To investigate the affecting of the operation opportunity of severe acute biliary pancreatitis (SABP) about prognosis and to study the risk factor affecting the mortality of this and to reduce postoperative mortality. Methods: The clinical data of 78 patients with SABP admitted to the department of surgery of our hospital were retrospectively analyzed. The operation opportunity, the cure rate, the relapse rate, the mortality rate and the risk factoring the mortality were analyzed in 78 patients with the SABP . Results: Based on the analysis of the treatment methods and its outcome , SABP should be divided into two types according to the duct obstruction and the timing of surgical .(1) There are 12 patients of non-obstructive mild type SABP received surgical operations with in 2 weeks after the onset, 7 cases were cured, 9 cases had complications, 5 cases died; of 42 patients received surgical operations after 2 weeks from onset, 38 cases were cured, 9 cases had complications, 4 cases died; (2) There are 10 patients of obstructive mild type SABP received surgical operations with in 2 weeks after the onset, 7 cases were cured, 6 cases had complications, 3 cases died; of 14 patients received surgical operations after 2 weeks from onset, 12 cases were cured, 7 cases had complications, 2 cases died. the incidence of complications and mortality had significantly difference in different operation opportunity of non- obstructive group. Multiple factor Logistic regression analysis indicated that the MODS(OR=15.35, P<0.05), APACHEⅡscore (OR=2.41, P<0.05) were the independent risk factor affecting the prognosis of SABP. Conclusion: The principle of individual operation is importance of SABP. The operation opportunity is one of the most important factors impact the mortality of SABP . The non-obstructive type patients should be cure of better in conservative way. Therefore, to make sure a reasonable operation opportunity and early prevention and correct management on the risk factors play critical roles in reducing the mortality of SABP.
引文
[1]雷若庆,张圣道.胆石性急性胰腺炎的外科治疗问题[J].中华肝胆外科杂志,2002;8(2):94-95.
[2] Liu CL,Lo CM,Chan J K,et al. EUS for detection of acult cholelithiasis in patients with idiopathic pancreatitis [J].Gastrointest Endosc,2000;51:28-32.
[3] KohutM,NowakA,Nowakowska-DuiawaE,et al.Presence and density of commonj bile duct microlithiasis in acute biliary pancreatitis [J].World J Gastroenterol,2002;8∶558-561.
[4]杨冬华,黄卫.重症急性胰腺炎病因及发病机制的研究进展[J].临床肝胆病杂志,2005,21(3):131-132.
[5]张圣道.急性胰腺炎,陈孝平主编外科学[M].北京:人民卫生出版社2005,690-692.
[6]陈权海,李清佩.急性胆源性胰腺炎的治疗和手术时机的选择[J].中国实用外科杂志,1998;1:26-27.
[7] Mann D,Hershman MJ,Hittinger R, et al. Multicentre audit of death from acute pancreatitis [J].Br J Surg, 1994;81(6):890-893.
[8] Andersson R,Andersson B,Andersson E,et al. Acute pancreatitis from cellar signalling to complicated clinical course [J]. HPB, 2007;9(6):414-420.
[9]耿小平.重症急性胰腺炎手术指征与时机探讨[J].肝胆外科杂志,2007;15(1):3-6.
[10] Stone HH,Fabian TC, Dunlop WE. Gallstone pancreatitis,biliary tract pathology in relation to time of operation [J].Am Surg,1981;194 (2) :305.
[11]刘胜利,陈峰,陈怀江.重症急性胰腺炎的非手术治疗[J].中华外科杂志,1995;33(3):54-55.
[12]张云峰,郭文平.重症急性胰腺炎33例临床分析[J].实用全科医学, 2004;2 (2) : 130- 131.
[13] Chiang DT,Anozie A,Fleming WR,et.al Comparative study on Acute Pancreatitis management [J].ANZ J Surg,2004;74:218-221.
[14]中华医学会外科学会胰腺组.急性胰腺炎的临床诊断及分级标准[J].中华外科杂志,1997;35(12):773-775.
[15]中华医学会外科分会胰腺外科学组.重症急性胰腺炎诊治指南[J].中华外科杂志,2007;45(11):727-729.
[16]赵玉沛.胆源性胰腺炎诊断标准与处理原则的探讨[J].中华肝胆外科杂志,2002;8(2):95-96.
[17] Reinhold C,Bret P M. Current status of MR cholangiopancreatograph [J]. AJR Am J Roentgenol,1996;166 (6): 81-85.
[18] Sperlongano P,Pisaniello D,Del Vel Viscovol,et al. Efficacy of magnetic resonance cholangiopancreatography in detecting common bile duct lithiasis:our experience [J].Chir Ital,2005;57(5):635-640.
[19]陶国清,吴力源,蒋志阳.磁共振胰胆管成像在胆源性胰腺炎中应用价值[J].临床外科杂志,2002;10 (2) :100-101.
[20] Sakai Y,Tsuyuguchi T,Tsuchiya S,et al.Diagnostic value of MRCP and indications for ERCP [J]. Hepatogastroenterology,2007;54(80):2212-15.
[21] Balthazar EJ,Freeny PC,van Sonnenberg E. Imaging and intervention in acute pancreatitis [J].Radiology,1994;193 (2) :297-306.
[22]王中秋,李维勤,黎介寿.重症急性胰腺炎的CT评价与动态观察[J].中国实用外科杂志,2003;23(9):566-568
[23] Banks PA,Gerzof S G, Langevin RE,et al.CT-guided aspiration of suspected pancreatic infection [J].Int J Pancreatol,1995;18 (2) :265-269.
[24]戴梦华,赵玉沛.胆源性胰腺炎的实验室诊断[J].胰腺病学,2002;1 (2) :74-76.
[25] Tenner S,Dubner H,Steinberg W,et al.Predicting gallstone pancreatitis with laboratory parameters:a meta-analysis [J].Am J Gastroenterol,1994;89(10):58-63.
[26]元海成,秦鸣放,王庆等.血脂肪酶在急性重症胰腺炎早期诊断中的价值[J].中国中西医结合外科杂志,2009,15(4):372-373.
[27]余袅,李永国,黄生福等.胆源性急性胰腺炎早期非手术治疗探讨[J].中国实用外科杂志,2004;24:158-160
[28] Mutinga M, Rosenbluth A, Tennner S M, et al . Dosemortality occur early or late in acute pancreatitis [J]. Int J Pancreatical, 2000;28: 91- 95.
[29]孙备,姜洪池,许军等.重症急性胰腺炎外科干预的时机,指征与方式选择[J].中国实用外科杂志,2005;25(7):414-416.
[30] Paye F,Rotman N,Radier C,etal. Percutaneous aspiration for bacteriological studies in patients with necrotizing pancreatitis [J].Br J Surg,1998;85 (6) :755-759
[31] Banks PA,Gerzof SG,Langevin RE,et al.CT-guided aspiration of suspected pancreatic infection [J].Int J Pancreatol,1995;18 (2) :265-269.
[32] Freeny PC,Hauptmann E,Althaus SJ,et al.Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis:techniques and results[J].AJR,1998;170 (4) :969-975。
[33]姜洪池,孙备,陆朝阳重症急性胰腺炎基本治疗原则初探[J].中华外科杂志,2007;45(1):6-8.
[34]雷若庆,张圣道胰腺坏死感染的手术指征,时机和方式选择[J].中国实用外科杂志,2003;23(9):518-520.
[35]李小军,夏霖,钱昆等.急性梗阻性化脓性胆管炎胆囊切除的时机选择附322例报告[ J ].中华肝胆外科杂志,2007;13(8):551-553
[36] Rahman SH,Larvm M,McMahon MJ.et al Clinical presentation and delayed treatment of cholargitis in older people [J]. Dig Dis Sci.2005;50:2207-2210.
[37] Leppaniemi A, Johansson K, De Wade JJ . Abdominal compartment syndrome and acute pancreatitis [J]. Acta Clin Belg Supp l, 2007; 1:l3 l-l35.
[38]王春友.重症急性胰腺炎手术时机选择的个体化问题[J].中华普通外科杂志,2003;18(6):325-326.
[39]余枭,雷若庆,韩天权等.胆源性重症胰腺炎手术时间的选择[J].中国实用外科杂志,2000;20(6):353-355.
[40]严律南.重症急性胰腺炎手术指征和时机的选择[J].中国实用外科杂志,1999;10 (9) :134-135.
[41]张震环,李维勤,王浩等.重症急性胰腺炎血流动力学和氧代谢变化的实验研究[J] .中国危重病急救医学,2004;16:715-718.
[42] Poves I , Fabregat J, Biondo S, et al . Results of treatment in severe acute pancreatitis [J]. Rev Esp Enferm Dig, 2000;92 (9) : 586-594.
[43] Mithofer K,Mueller PR,Warshaw AL. Interventional and surgical treatment of pancreatic abscess [J]. World J Surg, 1997; 21 ( 1 ) : 162-168.
[44] Werner J, Feuerbach S, et al . Management of acute pancreatitis : from surgery to interventional intensive care [J]. Gut,2005; 54 (3) : 426 - 436.
[45] Hammarstrom LE, Stridbeck H, Ihse I. Effect of endoscopic sphincterotomy and interval cholecystectomy on late outcome after gallstone pancreatitis [J]. Br J Surg, 1998; 85 (3) : 333 - 336.
[46] Alimoglu O, Ozkan OV, Sahin M, et al . Timing of cholecystectomy for acute biliary pancreatitis : outcomes of cholecystectomy on first admission and after recurrent biliary pancreatitis [J]. World J Surg, 2003;27 (3) : 256 - 259.
[47] Early endoscopic sphincterotomy and early laparoscopic cholecystectomy in the treatment of severe acute biliary pancreatitis--a preliminary report [J]. Adv-Med-Sci. 2006; 51: 103-104.
[48] [Anaya-Ayala JE,Porres Aguilar M, Mora-Loya CA et al. Severe acute pancreatitis: prognosis and treatment implications [J]. Rev-Gastroenterol-Mex. 2008;73(1): 40-46.
[49]何跃明,吕新生,艾中立等.重症急性胰腺炎合并深部真菌感染的预防和治疗[J].中国普通外科杂志,2003;12(2):83-86.
[50] Van-Santvoort HC,Besselink MG, de-Vries AC, et al. Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study [J]. Am-Surg. 2009; 250(1): 68-75
[51]张文杰,王雪峰,张勇等.内镜治疗急性胆源性胰腺炎的临床价值[J].上海交通大学学报,2007;27(8):1036-1037.
[52]郑晓玲,何利平,王丽珍等.急性胆源性胰腺炎早期内镜诊治结果报告[J].中华消化内镜杂志,2006;23(4):287-288.
[53]曲永清.急性胆源性胰腺炎内镜与传统治疗效果与安全性的随机对照观察[J].广东医学院学报,2007;25(4):395-396.
[54]邵永华,严振凯,王毅鑫.重症急性胰腺炎并发肺损伤的早期治疗[C],中华医学会首届行为医学大会论文,2004;1:191-192。
[55] Bchler MW,Gloor B,M ller CA,et al. Acute necrotizing pancreatitis:treatment strategy according to the status of infection [J].Am Sueg,2000;232(5):619-626
[56] Buter A,Imrie CW,Carter CR,et al. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis [J] .Br J Surg,2002;89:298-302.
[57]王约青,周鸣清,赵坚等APACHEⅡ,Ranson,Balthazar评估系统对重症急性胰腺炎诊断及预后评估的参考价值[J].临床外科杂志,2007;15(2):109-111
[58]孙备,董承刚,王刚等.重症急性胰腺炎死亡的高危因素分析[J].中华外科杂志,2007;45(23) :1619-1622
[59]王春友.进一步细化重症急性胰腺炎治疗方案的几个重要方面[J].临床外科杂志,2006;14(1):1-3.
[60]乔世峰,孙家邦,李非等.重症急性胰腺炎急性肾功能衰竭临床危险因素极其预防[J].中华肝胆外科杂志,2005;11:293-295.
[1] Kaska M, Pospisilova B, Slizova D. Pathomorphological changes in microcircu- lation of pancreas during experimental acute pancreatitis[J]. Hepato-gastroenterology 2000;47(36):1570.
[2] Sakorafas G.H and Tsiotou A.G. Etiology and pathogenesis of acute pancreatitis: Current concepts [J]. Journal of Clinical Gastroenterology, 2000;309(4):353-356.
[3] Menger M.D,Bonkhoff H,et al.Ischemia-Reperfusion-Induced Pancreatic Micro- vascular Injury: An Intravital Fluorescence Microscopic Study in Rats[J]. Digestive Diseases & Sciences, 1996;41(5):823-830.
[4] Obermaier, Robert, Drognitz, et al. Pancreatic Ischemia/Reperfusion Injury: Impact of Different Preservation Temperatures[J]. Pancreas , 2008;37(3):328-332.
[5]常华,严际慎等.缺血再灌注损伤对大鼠急性胰腺炎细胞凋亡的影响[J].中国普外基础与临床杂志. 2005;12(2):152.
[6] Von Dobschuetz E,Biberthaler P,et al. Noninvasive In Vivo Assessment of the Pancreatic Microcirculation: Orthogonal Polarization Spectral Imaging [J]. Pancreas , 2003;26(2):139-143.
[7] Woeste G, Wullstein C, Meyer S,et al. Octreotide attenuates impaired microcircu- lation in postischemic pancreatitis when administered before induction of ischemia [J]. Transplantation , 2008 Oct 15;86(7):961-967.
[8] Kusterer K,Poschmarin T,Friedema A,et al. Arterial constriction, ischemia- reperfusion, and leukocyte adherence in acute pancreatitis[J]. Am J physiol. 1993; 265(1): G165-171.
[9] Hua R, Li X, Long J.J, et al. Rat pancreatic microcirculatory changes following pancreatic ischemia-reperfusion injury [J]. Chinese Journal of Clinical Rehabilitation. 2005; 9(18): 152-154.
[10] Benz S, Obermaier R, Wiessner R,et al. Effect of nitric oxide in ischemia/reperfusion of the pancreas [J] .J Surg Res , 2002 Jul;106(1):46-53.
[11] Foitzik T, Eibl G., Hotz B,et al. Persistent multiple organ microcirculatory disorders in severe acute pancreatitis :experimental findings and clinical implications [J].Dig Dis Sci, 2002 Jan;47(1):130-138.
[12] Halonen KI., Pettila V.,et al. Multiple organ dysfunction associated with severe acute pancreatitis [J]. Crit Care Med , 2002 Jun;30(6):1274-1279.
[13]宋少伟,刘永峰.腺苷A2受体激动剂对大鼠胰腺缺血再灌注损伤时氧自由和细胞凋亡的影响[J].世界华人消化杂志,2008;16(27):3099-3102.
[14] Gnaiger E, Kuznetsov AV, Rieger G,et al. Mitochondrial defects by intracellular calcium overload versus endothelial cold ischemia/reperfusion injury [J]. Transpl Int. 2000;13(1):555-557.
[15] Kingsnorth A. Role of cytokines and their inhibitors in acute pancreatitis. [J].Gut,1997;40:1-4.
[16] Leindler L, Morschl E, et al. Importance of cytokines, nitric oxide, and apoptosis in the pathological process of necrotizing pancreatitis in rats [J]. Pancreas, 2004; 29(2): 157-161.
[17]吴宝强,秦锡虎,江勇. NF-κB在急性胰腺炎发病机制中的作用[J].苏州大学学报,2005;25(3):457-462.
[18] Furuichi, Kengo,et al. Interleukin-1-dependent sequential chemokine expression and inflammatory cell infiltration in ischemia-reperfusion injury [J]. Critical Care Medicine,2006;34(9):2447-2455.
[19]任晓葆,何振平,段恒春.急性出血坏死性胰腺炎大鼠血浆内皮素和一氧化氮变化及其意义[J].中国危重病急救医学,1998;10(6):369 -370.
[20] Folch E, Closa D, et al. Leukotriene generation and neutrophil infiltration after experimental acute pancreatitis [J]. Inflammation 1998; 22(1):83.
[21]张成,奕正刚等.磷脂酰肌醇3激酶/蛋白激酶B信号转导通路在重症急性胰腺炎中性粒细胞活化中的作用[J].世界华人消化杂志,2006;14(20):1987-1991.
[22] Uhlmann D, Lauer H,et al. Pathophysiological role of platelets and platelet system in acute pancreatitis [J] Microvascular Research, 2008; 76(2):114-123.
[23] Uhlmann D, Lauer H, Serr F,et al. Pathophysiological role of platelets in acute experimental pancreatitis: influence of endothelin A receptor blockade [J] .Cell Tissue Res.2007;27(3):485-492.
[24]吴云,陈纪伟血小板激活因子对急性胰腺炎血液流变学影响的实验研究[J].中华肝胆外科杂志,2006;12(2):133-134.
[25] Xi-ping Zhang, Jie Zhang,et al.Mechanism of acute pancreatitis complicated with injury of intestinal mucosa barrier [J]. J Zhejiang Univ Sci B, 2007; 8(12):888-895.
[26]党胜春,张建新等血清IL-2、IL-10及肠粘膜Fas在重症急性胰腺炎大鼠中的动态变化[J].世界华人消化杂志,2007;15(25)3697-3702.
[27] Flint R.S, Phillips A.R.J,et al.Acute pancreatitis severity is exacerbated by intestinal ischemia-reperfusion conditioned mesenteric lymph [J]. Surgery , 2008; 143(3):404-13.
[28] McHugh P,Turina M. Apoptosis and necrosis: A review for surgeons [J].Surgical Infections , 2006;7(1):53-68.
[29] Scarabelli TM, Stephanou A,et al. Different signaling pathways induce apoptosis in endothelial cells and cardiac myocytes during Ischemia/Reperfusion injury [J].Circ Res , 2002;90(6):745-748.
[30] Warzecha Z, Dembinski A,et al. Influence of ischemic preconditioning on blood coagulation, fibrinolytic activity and pancreatic repair in the course of caerulein–indu -ced acute pancreatitis in rats [J]. J Physiol Pharmacol, 2007 Jun;58(2):303-319.
[31] Cosen-Binker L.I, Binker M.G,et al. Relaxin prevents the development of severe acute pancreatitis [J].World Journal of Gastroenterology. 2006;12(10): 1558-1568.
[32] Cosen-Binker, Laura Iris,et al. Influence of Hydrocortisone, Prednisolone, and NO Association on the Evolution of Acute Pancreatitis [J]. Digestive Diseases & Sciences ,2006;51(5):915-925.
[33] Ceranowicz P, Warzecha Z,et al. Protective and therapeutic effect of leptin in acute pancreatitis evoked by ischemia/reperfusion [J].Folia Med Cracov,2003;44(12): 93-108.
[34] Munoz-Casares F.C, Padillo F.J,et al. Melatonin reduces apoptosis and necrosis induced by ischemia/reperfusion injury of the pancreas [J]. Journal of Pineal Research, 2006;40(3):195-203.
[35] Von Dobschuetz E,Schmidt R,et al.Protective role of heme oxygenase-1 in panc- reatic microcirculatory dysfunction after ischemia/reperfusion in rats [J]. Pancreas, 2008 may; 36(4): 377-384.
[36]吕新生,丘氟,李介秋等.低分子量肝素治疗重症急性胰腺炎的多中心前瞻性临床研究[J].中华普通外科杂志[J].2006;21(7):500-503.
[37] Ceranowicz P, Dembinski A, Warzecha Z,et al. Protective and therapeutic effect of heparin in acute pancreatitis [J]. J Physiol Pharmacol. 2008;59 (4):103-125.
[38] Christophi C, Millar I,et al. Hyperbaric oxygen therapy for severe acute pancreatitis [J].Journal of Gastroenterology and Hepatology ,2007;22(11): 2042-2046.
[2] Liu CL,Lo CM,Chan J K,et al. EUS for detection of acult cholelithiasis in patients with idiopathic pancreatitis [J].Gastrointest Endosc,2000;51:28-32.
[3] KohutM,NowakA,Nowakowska-DuiawaE,et al.Presence and density of commonj bile duct microlithiasis in acute biliary pancreatitis [J].World J Gastroenterol,2002;8∶558-561.
[4]杨冬华,黄卫.重症急性胰腺炎病因及发病机制的研究进展[J].临床肝胆病杂志,2005,21(3):131-132.
[5]张圣道.急性胰腺炎,陈孝平主编外科学[M].北京:人民卫生出版社2005,690-692.
[6]陈权海,李清佩.急性胆源性胰腺炎的治疗和手术时机的选择[J].中国实用外科杂志,1998;1:26-27.
[7] Mann D,Hershman MJ,Hittinger R, et al. Multicentre audit of death from acute pancreatitis [J].Br J Surg, 1994;81(6):890-893.
[8] Andersson R,Andersson B,Andersson E,et al. Acute pancreatitis from cellar signalling to complicated clinical course [J]. HPB, 2007;9(6):414-420.
[9]耿小平.重症急性胰腺炎手术指征与时机探讨[J].肝胆外科杂志,2007;15(1):3-6.
[10] Stone HH,Fabian TC, Dunlop WE. Gallstone pancreatitis,biliary tract pathology in relation to time of operation [J].Am Surg,1981;194 (2) :305.
[11]刘胜利,陈峰,陈怀江.重症急性胰腺炎的非手术治疗[J].中华外科杂志,1995;33(3):54-55.
[12]张云峰,郭文平.重症急性胰腺炎33例临床分析[J].实用全科医学, 2004;2 (2) : 130- 131.
[13] Chiang DT,Anozie A,Fleming WR,et.al Comparative study on Acute Pancreatitis management [J].ANZ J Surg,2004;74:218-221.
[14]中华医学会外科学会胰腺组.急性胰腺炎的临床诊断及分级标准[J].中华外科杂志,1997;35(12):773-775.
[15]中华医学会外科分会胰腺外科学组.重症急性胰腺炎诊治指南[J].中华外科杂志,2007;45(11):727-729.
[16]赵玉沛.胆源性胰腺炎诊断标准与处理原则的探讨[J].中华肝胆外科杂志,2002;8(2):95-96.
[17] Reinhold C,Bret P M. Current status of MR cholangiopancreatograph [J]. AJR Am J Roentgenol,1996;166 (6): 81-85.
[18] Sperlongano P,Pisaniello D,Del Vel Viscovol,et al. Efficacy of magnetic resonance cholangiopancreatography in detecting common bile duct lithiasis:our experience [J].Chir Ital,2005;57(5):635-640.
[19]陶国清,吴力源,蒋志阳.磁共振胰胆管成像在胆源性胰腺炎中应用价值[J].临床外科杂志,2002;10 (2) :100-101.
[20] Sakai Y,Tsuyuguchi T,Tsuchiya S,et al.Diagnostic value of MRCP and indications for ERCP [J]. Hepatogastroenterology,2007;54(80):2212-15.
[21] Balthazar EJ,Freeny PC,van Sonnenberg E. Imaging and intervention in acute pancreatitis [J].Radiology,1994;193 (2) :297-306.
[22]王中秋,李维勤,黎介寿.重症急性胰腺炎的CT评价与动态观察[J].中国实用外科杂志,2003;23(9):566-568
[23] Banks PA,Gerzof S G, Langevin RE,et al.CT-guided aspiration of suspected pancreatic infection [J].Int J Pancreatol,1995;18 (2) :265-269.
[24]戴梦华,赵玉沛.胆源性胰腺炎的实验室诊断[J].胰腺病学,2002;1 (2) :74-76.
[25] Tenner S,Dubner H,Steinberg W,et al.Predicting gallstone pancreatitis with laboratory parameters:a meta-analysis [J].Am J Gastroenterol,1994;89(10):58-63.
[26]元海成,秦鸣放,王庆等.血脂肪酶在急性重症胰腺炎早期诊断中的价值[J].中国中西医结合外科杂志,2009,15(4):372-373.
[27]余袅,李永国,黄生福等.胆源性急性胰腺炎早期非手术治疗探讨[J].中国实用外科杂志,2004;24:158-160
[28] Mutinga M, Rosenbluth A, Tennner S M, et al . Dosemortality occur early or late in acute pancreatitis [J]. Int J Pancreatical, 2000;28: 91- 95.
[29]孙备,姜洪池,许军等.重症急性胰腺炎外科干预的时机,指征与方式选择[J].中国实用外科杂志,2005;25(7):414-416.
[30] Paye F,Rotman N,Radier C,etal. Percutaneous aspiration for bacteriological studies in patients with necrotizing pancreatitis [J].Br J Surg,1998;85 (6) :755-759
[31] Banks PA,Gerzof SG,Langevin RE,et al.CT-guided aspiration of suspected pancreatic infection [J].Int J Pancreatol,1995;18 (2) :265-269.
[32] Freeny PC,Hauptmann E,Althaus SJ,et al.Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis:techniques and results[J].AJR,1998;170 (4) :969-975。
[33]姜洪池,孙备,陆朝阳重症急性胰腺炎基本治疗原则初探[J].中华外科杂志,2007;45(1):6-8.
[34]雷若庆,张圣道胰腺坏死感染的手术指征,时机和方式选择[J].中国实用外科杂志,2003;23(9):518-520.
[35]李小军,夏霖,钱昆等.急性梗阻性化脓性胆管炎胆囊切除的时机选择附322例报告[ J ].中华肝胆外科杂志,2007;13(8):551-553
[36] Rahman SH,Larvm M,McMahon MJ.et al Clinical presentation and delayed treatment of cholargitis in older people [J]. Dig Dis Sci.2005;50:2207-2210.
[37] Leppaniemi A, Johansson K, De Wade JJ . Abdominal compartment syndrome and acute pancreatitis [J]. Acta Clin Belg Supp l, 2007; 1:l3 l-l35.
[38]王春友.重症急性胰腺炎手术时机选择的个体化问题[J].中华普通外科杂志,2003;18(6):325-326.
[39]余枭,雷若庆,韩天权等.胆源性重症胰腺炎手术时间的选择[J].中国实用外科杂志,2000;20(6):353-355.
[40]严律南.重症急性胰腺炎手术指征和时机的选择[J].中国实用外科杂志,1999;10 (9) :134-135.
[41]张震环,李维勤,王浩等.重症急性胰腺炎血流动力学和氧代谢变化的实验研究[J] .中国危重病急救医学,2004;16:715-718.
[42] Poves I , Fabregat J, Biondo S, et al . Results of treatment in severe acute pancreatitis [J]. Rev Esp Enferm Dig, 2000;92 (9) : 586-594.
[43] Mithofer K,Mueller PR,Warshaw AL. Interventional and surgical treatment of pancreatic abscess [J]. World J Surg, 1997; 21 ( 1 ) : 162-168.
[44] Werner J, Feuerbach S, et al . Management of acute pancreatitis : from surgery to interventional intensive care [J]. Gut,2005; 54 (3) : 426 - 436.
[45] Hammarstrom LE, Stridbeck H, Ihse I. Effect of endoscopic sphincterotomy and interval cholecystectomy on late outcome after gallstone pancreatitis [J]. Br J Surg, 1998; 85 (3) : 333 - 336.
[46] Alimoglu O, Ozkan OV, Sahin M, et al . Timing of cholecystectomy for acute biliary pancreatitis : outcomes of cholecystectomy on first admission and after recurrent biliary pancreatitis [J]. World J Surg, 2003;27 (3) : 256 - 259.
[47] Early endoscopic sphincterotomy and early laparoscopic cholecystectomy in the treatment of severe acute biliary pancreatitis--a preliminary report [J]. Adv-Med-Sci. 2006; 51: 103-104.
[48] [Anaya-Ayala JE,Porres Aguilar M, Mora-Loya CA et al. Severe acute pancreatitis: prognosis and treatment implications [J]. Rev-Gastroenterol-Mex. 2008;73(1): 40-46.
[49]何跃明,吕新生,艾中立等.重症急性胰腺炎合并深部真菌感染的预防和治疗[J].中国普通外科杂志,2003;12(2):83-86.
[50] Van-Santvoort HC,Besselink MG, de-Vries AC, et al. Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study [J]. Am-Surg. 2009; 250(1): 68-75
[51]张文杰,王雪峰,张勇等.内镜治疗急性胆源性胰腺炎的临床价值[J].上海交通大学学报,2007;27(8):1036-1037.
[52]郑晓玲,何利平,王丽珍等.急性胆源性胰腺炎早期内镜诊治结果报告[J].中华消化内镜杂志,2006;23(4):287-288.
[53]曲永清.急性胆源性胰腺炎内镜与传统治疗效果与安全性的随机对照观察[J].广东医学院学报,2007;25(4):395-396.
[54]邵永华,严振凯,王毅鑫.重症急性胰腺炎并发肺损伤的早期治疗[C],中华医学会首届行为医学大会论文,2004;1:191-192。
[55] Bchler MW,Gloor B,M ller CA,et al. Acute necrotizing pancreatitis:treatment strategy according to the status of infection [J].Am Sueg,2000;232(5):619-626
[56] Buter A,Imrie CW,Carter CR,et al. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis [J] .Br J Surg,2002;89:298-302.
[57]王约青,周鸣清,赵坚等APACHEⅡ,Ranson,Balthazar评估系统对重症急性胰腺炎诊断及预后评估的参考价值[J].临床外科杂志,2007;15(2):109-111
[58]孙备,董承刚,王刚等.重症急性胰腺炎死亡的高危因素分析[J].中华外科杂志,2007;45(23) :1619-1622
[59]王春友.进一步细化重症急性胰腺炎治疗方案的几个重要方面[J].临床外科杂志,2006;14(1):1-3.
[60]乔世峰,孙家邦,李非等.重症急性胰腺炎急性肾功能衰竭临床危险因素极其预防[J].中华肝胆外科杂志,2005;11:293-295.
[1] Kaska M, Pospisilova B, Slizova D. Pathomorphological changes in microcircu- lation of pancreas during experimental acute pancreatitis[J]. Hepato-gastroenterology 2000;47(36):1570.
[2] Sakorafas G.H and Tsiotou A.G. Etiology and pathogenesis of acute pancreatitis: Current concepts [J]. Journal of Clinical Gastroenterology, 2000;309(4):353-356.
[3] Menger M.D,Bonkhoff H,et al.Ischemia-Reperfusion-Induced Pancreatic Micro- vascular Injury: An Intravital Fluorescence Microscopic Study in Rats[J]. Digestive Diseases & Sciences, 1996;41(5):823-830.
[4] Obermaier, Robert, Drognitz, et al. Pancreatic Ischemia/Reperfusion Injury: Impact of Different Preservation Temperatures[J]. Pancreas , 2008;37(3):328-332.
[5]常华,严际慎等.缺血再灌注损伤对大鼠急性胰腺炎细胞凋亡的影响[J].中国普外基础与临床杂志. 2005;12(2):152.
[6] Von Dobschuetz E,Biberthaler P,et al. Noninvasive In Vivo Assessment of the Pancreatic Microcirculation: Orthogonal Polarization Spectral Imaging [J]. Pancreas , 2003;26(2):139-143.
[7] Woeste G, Wullstein C, Meyer S,et al. Octreotide attenuates impaired microcircu- lation in postischemic pancreatitis when administered before induction of ischemia [J]. Transplantation , 2008 Oct 15;86(7):961-967.
[8] Kusterer K,Poschmarin T,Friedema A,et al. Arterial constriction, ischemia- reperfusion, and leukocyte adherence in acute pancreatitis[J]. Am J physiol. 1993; 265(1): G165-171.
[9] Hua R, Li X, Long J.J, et al. Rat pancreatic microcirculatory changes following pancreatic ischemia-reperfusion injury [J]. Chinese Journal of Clinical Rehabilitation. 2005; 9(18): 152-154.
[10] Benz S, Obermaier R, Wiessner R,et al. Effect of nitric oxide in ischemia/reperfusion of the pancreas [J] .J Surg Res , 2002 Jul;106(1):46-53.
[11] Foitzik T, Eibl G., Hotz B,et al. Persistent multiple organ microcirculatory disorders in severe acute pancreatitis :experimental findings and clinical implications [J].Dig Dis Sci, 2002 Jan;47(1):130-138.
[12] Halonen KI., Pettila V.,et al. Multiple organ dysfunction associated with severe acute pancreatitis [J]. Crit Care Med , 2002 Jun;30(6):1274-1279.
[13]宋少伟,刘永峰.腺苷A2受体激动剂对大鼠胰腺缺血再灌注损伤时氧自由和细胞凋亡的影响[J].世界华人消化杂志,2008;16(27):3099-3102.
[14] Gnaiger E, Kuznetsov AV, Rieger G,et al. Mitochondrial defects by intracellular calcium overload versus endothelial cold ischemia/reperfusion injury [J]. Transpl Int. 2000;13(1):555-557.
[15] Kingsnorth A. Role of cytokines and their inhibitors in acute pancreatitis. [J].Gut,1997;40:1-4.
[16] Leindler L, Morschl E, et al. Importance of cytokines, nitric oxide, and apoptosis in the pathological process of necrotizing pancreatitis in rats [J]. Pancreas, 2004; 29(2): 157-161.
[17]吴宝强,秦锡虎,江勇. NF-κB在急性胰腺炎发病机制中的作用[J].苏州大学学报,2005;25(3):457-462.
[18] Furuichi, Kengo,et al. Interleukin-1-dependent sequential chemokine expression and inflammatory cell infiltration in ischemia-reperfusion injury [J]. Critical Care Medicine,2006;34(9):2447-2455.
[19]任晓葆,何振平,段恒春.急性出血坏死性胰腺炎大鼠血浆内皮素和一氧化氮变化及其意义[J].中国危重病急救医学,1998;10(6):369 -370.
[20] Folch E, Closa D, et al. Leukotriene generation and neutrophil infiltration after experimental acute pancreatitis [J]. Inflammation 1998; 22(1):83.
[21]张成,奕正刚等.磷脂酰肌醇3激酶/蛋白激酶B信号转导通路在重症急性胰腺炎中性粒细胞活化中的作用[J].世界华人消化杂志,2006;14(20):1987-1991.
[22] Uhlmann D, Lauer H,et al. Pathophysiological role of platelets and platelet system in acute pancreatitis [J] Microvascular Research, 2008; 76(2):114-123.
[23] Uhlmann D, Lauer H, Serr F,et al. Pathophysiological role of platelets in acute experimental pancreatitis: influence of endothelin A receptor blockade [J] .Cell Tissue Res.2007;27(3):485-492.
[24]吴云,陈纪伟血小板激活因子对急性胰腺炎血液流变学影响的实验研究[J].中华肝胆外科杂志,2006;12(2):133-134.
[25] Xi-ping Zhang, Jie Zhang,et al.Mechanism of acute pancreatitis complicated with injury of intestinal mucosa barrier [J]. J Zhejiang Univ Sci B, 2007; 8(12):888-895.
[26]党胜春,张建新等血清IL-2、IL-10及肠粘膜Fas在重症急性胰腺炎大鼠中的动态变化[J].世界华人消化杂志,2007;15(25)3697-3702.
[27] Flint R.S, Phillips A.R.J,et al.Acute pancreatitis severity is exacerbated by intestinal ischemia-reperfusion conditioned mesenteric lymph [J]. Surgery , 2008; 143(3):404-13.
[28] McHugh P,Turina M. Apoptosis and necrosis: A review for surgeons [J].Surgical Infections , 2006;7(1):53-68.
[29] Scarabelli TM, Stephanou A,et al. Different signaling pathways induce apoptosis in endothelial cells and cardiac myocytes during Ischemia/Reperfusion injury [J].Circ Res , 2002;90(6):745-748.
[30] Warzecha Z, Dembinski A,et al. Influence of ischemic preconditioning on blood coagulation, fibrinolytic activity and pancreatic repair in the course of caerulein–indu -ced acute pancreatitis in rats [J]. J Physiol Pharmacol, 2007 Jun;58(2):303-319.
[31] Cosen-Binker L.I, Binker M.G,et al. Relaxin prevents the development of severe acute pancreatitis [J].World Journal of Gastroenterology. 2006;12(10): 1558-1568.
[32] Cosen-Binker, Laura Iris,et al. Influence of Hydrocortisone, Prednisolone, and NO Association on the Evolution of Acute Pancreatitis [J]. Digestive Diseases & Sciences ,2006;51(5):915-925.
[33] Ceranowicz P, Warzecha Z,et al. Protective and therapeutic effect of leptin in acute pancreatitis evoked by ischemia/reperfusion [J].Folia Med Cracov,2003;44(12): 93-108.
[34] Munoz-Casares F.C, Padillo F.J,et al. Melatonin reduces apoptosis and necrosis induced by ischemia/reperfusion injury of the pancreas [J]. Journal of Pineal Research, 2006;40(3):195-203.
[35] Von Dobschuetz E,Schmidt R,et al.Protective role of heme oxygenase-1 in panc- reatic microcirculatory dysfunction after ischemia/reperfusion in rats [J]. Pancreas, 2008 may; 36(4): 377-384.
[36]吕新生,丘氟,李介秋等.低分子量肝素治疗重症急性胰腺炎的多中心前瞻性临床研究[J].中华普通外科杂志[J].2006;21(7):500-503.
[37] Ceranowicz P, Dembinski A, Warzecha Z,et al. Protective and therapeutic effect of heparin in acute pancreatitis [J]. J Physiol Pharmacol. 2008;59 (4):103-125.
[38] Christophi C, Millar I,et al. Hyperbaric oxygen therapy for severe acute pancreatitis [J].Journal of Gastroenterology and Hepatology ,2007;22(11): 2042-2046.