Chaudhary A, Dhar P, Sachdev A, Agarwal A K
Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital, New Delhi, India.
Br J Surg. 1997 Jul;84(7):965-8. doi: 10.1002/bjs.1800840716.
Local complications of pancreatic necrosis may occur after surgery, but when they occur spontaneously render surgical treatment more hazardous and impair prognosis.
A retrospective review was carried out of 83 patients who underwent surgery for pancreatic necrosis from 1988 to 1995, to determine the incidence, type, treatment and outcome of locoregional complications caused by pancreatic necrosis associated with acute pancreatitis.
Seventeen patients (20 per cent) were identified to have intra-abdominal complications with pancreatic necrosis either before operation or at the time of surgery. The majority of patients had a delay in intervention (mean 46 days). At presentation ten of the 17 patients had one or more organ system failures. Fourteen patients had gastrointestinal tract involvement, two had involvement of the biliary tract and one patient had a splenic rupture. Six patients died.
In patients with pancreatic necrosis, development of locoregional complications is associated with a high mortality rate. The presence of gastrointestinal bleeding, peritonitis, jaundice or pneumoperitoneum in such patients suggests the presence of a complication of the necrotic process and should prompt early intervention. Early referral of patients with severe acute pancreatitis to specialized units may reduce the risk of locoregional complications.
胰腺坏死的局部并发症可能在手术后出现，但当它们自发发生时，会使手术治疗风险更高并影响预后。
对1988年至1995年接受胰腺坏死手术的83例患者进行回顾性研究，以确定与急性胰腺炎相关的胰腺坏死引起的局部并发症的发生率、类型、治疗方法及结果。
17例患者（20%）在术前或手术时被发现有胰腺坏死相关的腹腔内并发症。大多数患者干预延迟（平均46天）。17例患者中有10例在就诊时出现一个或多个器官系统功能衰竭。14例患者有胃肠道受累，2例有胆道受累，1例患者脾破裂。6例患者死亡。
在胰腺坏死患者中，局部并发症的发生与高死亡率相关。此类患者出现胃肠道出血、腹膜炎、黄疸或气腹提示存在坏死过程的并发症，应促使早期干预。将重症急性胰腺炎患者早期转诊至专科单位可能会降低局部并发症的风险。
