Aldridge M C, Ornstein M, Glazer G, Dudley H A
Br J Surg. 1985 Oct;72(10):796-800. doi: 10.1002/bjs.1800721008.
Non-operative management of acute necrotizing pancreatitis carries a mortality of up to 80 per cent. Over the last 6 years we have pursued an aggressive policy of intensive supportive therapy followed by pancreatic resection in those patients with this severe form of the disease. We have managed 15 patients in this way, 14 by subtotal pancreatic resection (usually body and tail of the gland) and one by total pancreatectomy; 7 had early overwhelming multi-system failure with a median of 4 positive prognostic factors whilst 8 were operated on later between 3 and 8 weeks (plus one at 32 weeks) and had varying clinical pictures. Eight patients had ischaemia of the transverse colon which was noted at operation in four, and presented postoperatively in the remainder. Re-operation was necessary in 13 patients to remove further slough or resect ischaemic bowel. Five patients (33 per cent) died between 10 days and 4 weeks postoperatively, death being due to sepsis and multi-system failure in four and a massive retroperitoneal haemorrhage in one. Of the ten survivors, four require insulin. Timely excision of necrotic pancreatic tissue combined with intensive supportive therapy may help reduce the high mortality in this condition.
急性坏死性胰腺炎的非手术治疗死亡率高达80%。在过去6年里，我们采取了积极的强化支持治疗策略，对于患有这种严重疾病形式的患者，在强化支持治疗后进行胰腺切除术。我们用这种方法治疗了15例患者，14例行胰腺次全切除术（通常是胰体和胰尾），1例行全胰切除术；7例早期出现严重的多系统功能衰竭，平均有4个阳性预后因素，而8例在3至8周（另有1例在32周）后接受手术，临床表现各异。8例患者出现横结肠缺血，术中发现4例，其余患者术后出现。13例患者需要再次手术以清除更多坏死组织或切除缺血肠段。5例患者（33%）在术后10天至4周内死亡，4例死于败血症和多系统功能衰竭，1例死于大量腹膜后出血。10名幸存者中，4例需要胰岛素治疗。及时切除坏死胰腺组织并结合强化支持治疗可能有助于降低这种疾病的高死亡率。
