Ranson J H
Department of Surgery, New York University Medical Center, NY 10016.
Ann Surg. 1990 Apr;211(4):382-93. doi: 10.1097/00000658-199004000-00002.
Surgical intervention in acute pancreatitis may have varied goals. Early laparotomy may be required for diagnostic purposes. There is, however, no convincing evidence that attempts to reduce the morbidity of severe pancreatitis by early operative pancreatic drainage, early formal pancreatic resection, or early biliary procedures have been effective. In fact, they may be harmful. Peritoneal lavage by catheter induced under local anesthesia may ameliorate early cardiovascular and respiratory complications in some patients. Preliminary experience suggests that early operative debridement of devitalized pancreatic tissue with postoperative lavage may be helpful in selected patients. Patients with infections of devitalized pancreatic or peripancreatic tissue require operative debridement and drainage or packing. Other complications such as colonic necrosis or pseudocysts also require operative treatment. Rarely do patients require operation to relieve protracted pancreatitis. Patients with gallstone-associated pancreatitis should usually undergo surgical correction of their cholelithiasis as soon as their pancreatitis has subsided.
急性胰腺炎的手术干预可能有不同的目标。早期剖腹手术可能用于诊断目的。然而，没有令人信服的证据表明，通过早期手术性胰腺引流、早期正规胰腺切除术或早期胆道手术来降低重症胰腺炎的发病率是有效的。事实上，这些手术可能有害。局部麻醉下经导管进行的腹腔灌洗在某些患者中可能改善早期心血管和呼吸系统并发症。初步经验表明，对失活胰腺组织进行早期手术清创并术后灌洗，可能对部分选定患者有帮助。失活胰腺或胰周组织感染的患者需要手术清创、引流或填塞。其他并发症，如结肠坏死或假性囊肿，也需要手术治疗。很少有患者需要手术来缓解迁延性胰腺炎。胆石相关性胰腺炎患者通常应在胰腺炎消退后尽快接受胆囊结石的手术矫正。
