Schröder T, Sainio V, Kivisaari L, Puolakkainen P, Kivilaakso E, Lempinen M
Second Department of Surgery, Helsinki University Central Hospital, Finland.
Ann Surg. 1991 Dec;214(6):663-6. doi: 10.1097/00000658-199112000-00004.
Twenty-one patients with acute fulminant alcoholic pancreatitis were randomly allocated to either pancreatic resection group (11 patients) or nonoperative peritoneal lavage group (10 patients). Only patients under 50 years were included in the study to minimize the role of other severe disease. These patients represented the most severe cases of acute pancreatitis at our Department, constituting only 2% of all patients with acute pancreatitis during this period. The diagnosis was based on clinical symptoms and on signs indicating severely impaired systemic organ functions. All patients underwent contrast-enhanced computed tomography (CT), which showed contrast enhancement below 30 Hounsfield units. In the operated cases, the diagnosis of necrotizing pancreatitis was verified histologically. All patients with conservative treatment had dark brown fluid at peritoneal puncture. There was a difference (nonsignificant) in mortality (3/11 and 1/10, respectively), complication rate, or in the need of reoperations between the groups. Nonoperative peritoneal lavage was followed with shorter treatment at the intensive care unit (16.2 versus 25.9 days, respectively). The hospital stay also was significantly shorter in the nonoperative group (44.3 versus 56.1 days). The results indicate that intensive conservative treatment is justified as an initial therapy even in the most severe cases of acute pancreatitis.
21例急性暴发性酒精性胰腺炎患者被随机分为胰腺切除组（11例）和非手术腹腔灌洗组（10例）。仅纳入50岁以下的患者以尽量减少其他严重疾病的影响。这些患者代表了我们科室最严重的急性胰腺炎病例，在此期间仅占所有急性胰腺炎患者的2%。诊断基于临床症状和提示全身器官功能严重受损的体征。所有患者均接受了对比增强计算机断层扫描（CT），结果显示对比增强低于30亨氏单位。在手术病例中，坏死性胰腺炎的诊断经组织学证实。所有接受保守治疗的患者腹腔穿刺均抽出深棕色液体。两组在死亡率（分别为3/11和1/10）、并发症发生率或再次手术需求方面存在差异（无统计学意义）。非手术腹腔灌洗后在重症监护病房的治疗时间较短（分别为16.2天和25.9天）。非手术组的住院时间也明显较短（44.3天对56.1天）。结果表明，即使在最严重的急性胰腺炎病例中，强化保守治疗作为初始治疗也是合理的。
