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題 名 | Experience in Surgical Treatment of Pancreatic Abscess=胰臟膿瘍外科治療之經驗 |
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作 者 | 趙子傑; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 21:3 1988.05[民77.05] |
頁 次 | 頁251-257 |
分類號 | 416.248 |
關鍵詞 | 外科治療; 胰臟膿瘍; |
語 文 | 英文(English) |
中文摘要 | 胰臟膿瘍是一種少見但卻具有致命性的胰臟炎併發性,其發生比傘為2%至5%。胰臟膿瘍的診斷常常延遲,這主要是因為其症狀多變且不明顯。體外引流胰臟膿瘍是目前公認的治療方法,但其死亡率仍舊很高。介於30%與70%之間。本文係報告長庚紀念醫院八年六個月期間,十八例胰臟膿瘍接受外科治療的經驗。從民國66年元月至74年6月,總共有670例急性胰臟炎,其中18例併發膿瘍,發生率為27%。呈現的症狀大部份為發燒、腹痛、腹脹、腹部腫瘤、噁心、嘔吐、黃疸、吐血及血清澱粉跨酶上升,但這些都不具特異性,而一般的X光檢查較常見的為助膜腔積水及泡沫狀之表徵。在本研究之後兩年本院設備有電腦斷層攝影儀器之後有4例膿瘍可在手術前得到正確的診斷且對於膿瘍的位置與範圍可以清楚地顯示出。手術的方法分別兩種,一種是引流管加上連續低壓抽取,另一種為開放性引流,其死亡率分別是25.0%及33.3%。總共有5例死亡,佔27.8%,其死因皆為不能控制的敗血症併發多重器官衰竭。併發症中有七例發生出血現象,其出血來源上消化出血6例,下消化道出血1例,從膿瘍腔大量也血者有4例,此4例均同時併有上消化道出血。二例有瀰散性血管內凝血病變(DIC),3例與腸胃道有瘻管發生,6例有糖尿病。6例糖尿病患者均可經由胰島素控制其血糖。其他較少見的併發症為胰臟瘻管,小的胰臟假性囊腫、肺炎及殘留膿瘍等。 我們建議對於急性胰臟炎患者保持高度之警覺性以期能移早期診斷胰臟膿瘍而給予體外引流。而電腦斷層攝影不失為一種精確的輔助診斷工具,可用以提升手術前正確之診斷率。 |
英文摘要 | Eighteen patients with pancreatic abscess were diagnosesed from among 670 patients hospitalized for acute pancreatitis (2.7%). Fifteen patients were classified. as primary, following acute or subsiding pancreatitis. Three, thought to have pseudocysts with unexplained fever and leukocytosis were secondary. Computerized tomography (CT) perfonned for four patients could clearly delineate the nature and extent of the disease. Sump drainage and open packing (marsupialization) were used for extemal drainage. Five patients died, a mortality rate of 27.8%. All deaths were due to uncontrollable sepsis and complicated by respiratory failure, sudden massive hemorrhage, disseminated intravascular coagulopathy and renal failure. The mortality rate was 33.3% in the marsupialization group and 25.0% in the sump drainage group. Although marsupialization provided a good method for removing large pieces of sloughed necrotic pancreatic tissue, it obtained no better results than multiple sump drains, in this series. |
本系統中英文摘要資訊取自各篇刊載內容。