Smadja C, Bismuth H
Gastroenterol Clin Biol. 1984 Jun-Jul;8(6-7):536-40.
Fifty-two patients operated for acute necrotising pancreatitis are reported. All severely-ill patients, operated early in order to perform a necrosectomy, died subsequently. Patients without severe illness were operated either for a complication of their pancreatic necrosis or electively for biliary lithiasis. The postoperative mortality was 29 p. 100 and 0 p. 100 respectively. Pancreatic necrosectomies were associated with a high morbidity whether performed for complications (64 p. 100) or during elective biliary surgery (33 p. 100). From this study, it appears that there is no indication for early necrosectomy in the severe forms of acute necrotising pancreatitis. However, pancreatic abscess remains a formal indication for drainage. It seems also justified to perform elective surgery without necrosectomy for biliary lithiasis complicated by acute necrotising pancreatitis.
本文报告了52例接受急性坏死性胰腺炎手术的患者。所有病情严重且早期接受坏死组织清除术的患者均在术后死亡。病情不严重的患者则因胰腺坏死并发症或因胆石症而接受择期手术。术后死亡率分别为29%和0%。无论坏死组织清除术是用于治疗并发症（64%）还是在择期胆道手术期间进行（33%），其发病率都很高。从这项研究来看，对于重症急性坏死性胰腺炎，似乎没有早期进行坏死组织清除术的指征。然而，胰腺脓肿仍然是进行引流的明确指征。对于并发急性坏死性胰腺炎的胆石症患者，在不进行坏死组织清除术的情况下进行择期手术似乎也是合理的。
