A Comparative Study On Curative Effect Of Different Therapy For 81 Cases Of Severe Acute Pancreatitis

Severe acute pancreatitis (SAP) is a serious acute abdominal disease, with a high rate of mortality. With more understanding about pathogenesis and pathologic course of SAP, the development in clinical technology, more improvement have taken place in the treatment, but the incidence of SAP and serious complications of SAP are still fairly high. The complications of SAP are the main cause of clinical death of patients. How to diagnose SAP early and treat it correctly, how to prevent and cure the complication of SAP directly influence the patient's prognosis.-4 -Objective: This study is to investigate relative reasonable therapeutic for SAP and to explore methods to prevent and cure it's serious complication to provide some basis for improving treatment of SAP.Methods: The clinical data of 81 cases of SAP treated in our hospital from Jan. 1989 to Dec. 2001 were retrospectively analyzed. Eight-one cases were allocated into two groups: 38 cases were early operated (Once SAP was diagnosed, patients who were no improvement or deterioration should be operated early after positive monitor and preparation for 4 to 8 hours). 43 cases were treated by means of individual systematic therapy (Biliary SAP with biliary obstruction need emergency operation; that without biliary obstruction operated after condition improved. Non-biliary SAP emphasize early non-operative treatment: including the prevention to circulation failure, maintaining the balance of body fluid, improving the circulation of pancreas, inhibiting the exocrine of pancreas, promoting the recovery function of bowels, applying Antibiotic for preventing infection, monitoring vital sign and organ function, cure the organ dysfunction positively, operation when infection happening). The results are analyzed by SPSS 10.0 statistical software, a value equal to 0.05 were considered test standard.Results: Twenty-one cases were cured in the early operation group, with a cure rate of 55.26%. Rate of complication of the early operation group: Shock (31.57%), Acute respiratory distress syndrome (ARDS) (39.47%),Acute renal failure (ARF) (21.05%), Multiple organ dysfunction syndrome (MODS) (23.98%), Intraperit-oneal infection (42.11%), Pancreatic fistula (23.68%), Intestinal fistula (15.78%), Pancreatic pseudocyst (21.05%), Gastrointestinal bleeding (28.95%). Three-five cases were cured in the individual systematic therapy group, with a cure rate of 81.40%. Rate of complication of the early operation group: Shock (19.75%), ARDS (25.93%), ARF (14.81%), MODS (13.58%), Intraperitoneal infection (29.63%), Pancreatic fistula (13.58%), Intestinal fistula (8.64%), Pancreatic pseudocyst (16.05%), Gastrointestinal bleeding (17.28%).Conclusions: The effect of the individual systematic therapy is superior to the early operation. During the prevention and therapy to early serious complication of SAP, we should pay attention to the treatment of shock, the prevention of infection, the control the pathologic change of pancreas, the protection to the function of organs and proper nutritious support. Serious complication such as accompanied infection, pancreatic fistula, intestinal fistula andgastrointestinal bleeding of later stage of SAP should be prevented and controlled, and combined with operation.