Hollender L F, Meyer C, Kauffmann J P, Keller D, Seguin J, Pagliano G
J Chir (Paris). 1983 Nov;120(11):595-601.
Three degrees of severity could be recognized in 58 patients operated upon for severe acute hemorrhagic pancreatitis, based on results of intensive care, particularly anti-shock therapy, wide peritoneal lavage, and possible need for endoscopic relief of sphincter of Oddi obstruction due to a stone. The principal parameters evaluated were clinical and biological features and the course of the affection. As a result of these data, 44 pancreatic resections of variable extension and 14 excisions of necrotic tissues were performed. Results of these two types of operations, as well as the dominant causes of postoperative and secondary deaths, are analyzed in detail. The indications for surgery are discussed, together with the tactical methods to be applied as a function of the general condition and the detailed study of the pancreas and the state of the adjacent organs. Particular importance should be attached to the presence of respiratory insufficiency. The possible need for routine biliary external drainage is discussed, and the major role played by parenteral nutrition, which should be initiated as early as possible, is emphasized. These findings suggest that two fundamental principles should guide surgery of acute hemorrhagic pancreatitis: the need for surgery in selected cases, though over-aggressive operations should be avoided, and, more particularly, the concept, to be shared of the need for repeated operations, enabling avoidance of excessive procedures during initial surgery.
根据重症监护结果，尤其是抗休克治疗、广泛的腹腔灌洗以及因结石导致的Oddi括约肌梗阻可能需要内镜解除梗阻的情况，对58例接受重症急性出血性胰腺炎手术的患者的严重程度进行了三级分类。评估的主要参数为临床和生物学特征以及病情发展过程。基于这些数据，进行了44例不同范围的胰腺切除术和14例坏死组织切除术。详细分析了这两种手术类型的结果以及术后死亡和继发性死亡的主要原因。讨论了手术指征，以及根据患者一般状况、胰腺详细检查结果和相邻器官状态应采用的策略方法。应特别重视呼吸功能不全的存在。讨论了常规胆汁外引流的必要性，并强调了尽早开始肠外营养的重要作用。这些发现表明，急性出血性胰腺炎手术应遵循两条基本原则：在特定病例中需要进行手术，但应避免过度激进的手术，更具体地说，应形成反复手术的理念，以避免初次手术时的过度操作。
