Peng S Y
Second Affiliated Hospital of Zhejiau Medical University, Hangzhou.
Zhonghua Wai Ke Za Zhi. 1991 Feb;29(2):107-9, 142-3.
The timing for surgical intervention and the type of operation in the treatment of severe pancreatitis are still controversial. In this study, we used closed marsupialization in which early operation was preferable and after decompression of the pancreas and necrosectomy, both edges of the opened greater omentum were sutured respectively to the upper and lower peritoneal borders of the transverse abdominal incision, forming a marsupium separating the greater and lesser abdominal cavities from each other. The abdominal incision was then sutured to close the opening of the marsupium. Should clinical features or CT, BUS scan have indicated the existence of pancreatic abscess a week or longer after the exploration, stiches of the abdominal wall incision were removed. The marsupium was easily reentered and necrotic tissue removed. As the omentum edges were adhered to the abdominal wall incision separating the greater and lesser abdominal cavities, reoperation was safe. The incision was then kept open (delayed marsupialization). The theoretical basis of the operation and satisfactory clinical results are discussed.
重症胰腺炎治疗中手术干预的时机及手术方式仍存在争议。在本研究中，我们采用了封闭袋形缝术，此方法更倾向于早期手术，在胰腺减压及坏死组织清除术后，将打开的大网膜的两边分别缝合于腹部横切口的上、下腹膜边缘，形成一个将大、小腹腔分隔开的袋状结构。然后缝合腹部切口以封闭袋状结构的开口。如果在探查一周或更长时间后临床症状或CT、BUS扫描提示存在胰腺脓肿，则拆除腹壁切口缝线。袋状结构很容易重新打开并清除坏死组织。由于网膜边缘附着于腹壁切口，分隔了大、小腹腔，再次手术是安全的。然后将切口保持开放（延迟袋形缝术）。本文讨论了该手术的理论基础及满意的临床结果。
