Analysis Of The Diagnosis And Treatment Of Residual Complications Of Moderately Severe Acute Pancreatitis And Severe Acute Pancreatitis

Objective:To summarize the experience of diagnosis and treatment of the complications of Moderately severe acute pancreatitis(MSAP) and Severe acute pancreatitis(SAP), and to improve the prognosis of the patients with severe acute pancreatitis.Methods:The data of the 286 cases with the MSAP and SAP in the deparment of general surgery of Fujian Medical University Union Hospital from January 2008 to May 2015.In accordance with Chinese medicine will society of pancreas surgery study group of 2014 set < Guideline for acute pancreatitis(2014) > definition of MSAP and SAP; MSAP and SAP residual complications for MSAP and SAP since the date of onset of after surgical or non-surgical treatment 2 months still exist need operative or non operative treatment to cure or control of complications To arrival at a conclusion of the residual complications of Moderately severe acute pancreatitis and Severe acute pancreatitis by analyze and summarize the types of residual complications( infected pancreatic necrosis, intraperitoneal or gastrointestinal bleeding, alimentary tract fistula associated and pancreatic pseudocysts), clinical manifestations, diagnostic methods, treatment measures and prognosis.Results:These complications occurred in 62 patients from the 286 patients of patients,incidence rate was 21.68%.32 patients of pancreatic pseudocysts and 30 patients of pancreatic necrosis infection.Pancreatic pseudocyst 32 cases(11.2%),19 patients of pancreatic pseudocyst,which the diameter is less than or equal to 6cm, 18 patients with conservative treatment, 1 patients were cured by minimally invasive surgery; 13 patients of pancreatic pseudocyst,which the diameter is more than 6cm, 9 patients with conservative treatment, 2 patients were cured by minimally invasive surgery and 2 patients were cured by operation,the cure rate 100%.5 patients Merge the pancreatic pseudocysts infection, bleeding or oppression symptoms,2 patients were cured by minimally invasive surgery and 3 patients were cured by operation,27 patients without merge the pancreatic pseudocysts infection, bleeding or oppression symptoms,all cured by conservative treatment.30 patients of pancreatic infection necrosis and its complications.Including 7 patients of ipancreatic infection necrosis;operation in 7 patients, 2 patients were cured by operation after minimally invasive surgery, the cure rate 100%.One kind of residual complication were 19 patients.Including 15 patients of alimentary tract fistula associated and 4 patients of pancreatic pseudocysts. Including 8 patients of intestinal fistula and 3 patients of biliary fistula, 6 patients of pancreatic fistula and 3 patients of biliary fistula were cured by conservative treatment,operation in 2 patients,the cure rate 100%; 3 patients of colon fistula cured by operation; 1 patients of duodenal fistula cured by conservative treatment; 4 patients of pancreatic pseudocyst, 3 patients were cured by conservative treatment and 1 patients were cured by operation.Another 4 patients of pancreatic pseudocyst after Pancreatic necrosis infection, 4 patients were cured. 4 patients residual two kinds of residual complication treatment of open operation, 2 patients condition postoperative peripancreatic repeatedly heavy bleeding can not effectively control and ultimately death, 2 patients were cured.Conclusion:(1)Infected pancreatic necrosis, Intraperitoneal bleeding or Gastrointestinal bleeding, Alimentary tract fistula associated and Pancreatic pseudocysts are the main complication of MSAP and SAP in the later stage.(2)Patients with pancreatic pseudocyst can be cured by conservative, Minimally invasive used when emerge the complications pancreatic pseudocyst shuould be drainage, surgical treatment is the last effect treatment?(3)Patients with pancreatic infection necrosis all should be the surgery, surgery time according to the results of the clinical manifestations and CT comprehensive consideration;General condition difference can not tolerate surgery can puncture drainage first.(4) Patients with pancreatic fistula and biliary fistula at most time could be cured by unobstructed drainage,all the Colon fistula should be surgical treatment.(5)Abdominal or gastrointestinal bleeding wsa high fatality rate, should be timely surgical hemostasis by surgical treatmen and unobstructed drainage.