Objective To study the combined surgical indication of regional arterial infusion (RAI) for treatment of severe acute pancreatitis (SAP), Methods The cases treated by operation combined with RAI in early stage, or from RAI converting to operation, or combined operation after the state of illness of SAP recovered were analyzed. Results (1) Four cases were treated by operation combined with RAI in early stage, one fulminant acute pancreatitis, one abdominal compartment syndrome (ACS); one case who underwent operation to terminate pregnancy drained peripancreatic effusion, RAJ was applied after that; one case conveyed from other hospital where he underwent operation in early stage was treated with RAI in our hospital because the illness grew worse. (2) Four cases were transformed to be operated during the course of treatment, of whom, one was transformed to biliary decompression because of biliary obstruction; one was for the range of liquefaetive necrosis enlarged; one was treated with twice operations because localized infectious necrotic loci appeared and finally the patient was Head; one was treated with twice operations because ACS was accompanied and finally the patient was dead. (3) Five cases were treated with delayed operation after the state of illness of SAP was recovered, of whom, one case was pancreatic pseudocyst; one case had enclosed mass in the head of pancreas that cannot subside; other 3 rases complicating gallstone were operated in the same time of hospitalization. Conclusion (1) ACS is the surgical indication of operation combined with RAI in early stage for the treatment of SAP. (2) The cases with obstructive severe acute gallstone pancreatitis need only ordinary operation in early stage, but when the biliary obstruction appeared during the course of treatment, converting; operation is needed. (3) The cases whose localized infectious necrotie loci appeared or the range of liquefactive necrosis enlarged during the course of RAI should be transformed to operation. (4) The cases who with unstable fulminant acute pancreatitis mav he treated by operation combined with RAI.%目的 探讨早期区域动脉灌注治疗(RAI)重症急性胰腺炎需要联合手术的指征.方法 对采用早期RAI联合早期手术、中转手术、以及病情控制后延期手术治疗的重症急性胰腺炎病例进行分析.结果 (1)联合早期手术共4例:其中1例属暴发性胰腺炎,1例属腹腔室间隔综合征(ACS),1例需终止妊娠者联合胰周引流术,术后加行RAI,1例在外院早期手术后病情加重转入我院后加行RAI.(2)治疗过程中中转手术共4例:其中1例出现胆道梗阻而中转胆道减压术,1例出现液化坏死范围扩大,1例出现局限性感染坏死灶行二次手术而死亡,1例出现ACS行二次手术而死亡.(3)病情控制后行延期手术共5例:其中1例胰腺假性囊肿,1例胰头包块不能消退,另3例合并胆囊结石者在同一次住院期间手术.结论 (1) ACS是RAI联合早期手术的指征.(2)存在胆道梗阻的胆源性胰腺炎一般仅需早期手术即可,但在RAI治疗过程中出现胆道梗阻需中转手术.(3)RAI过程中出现局限化感染坏死灶或液化坏死灶扩大者应中转手术.(4)不能稳定的“暴发性胰腺炎”可试用联合手术治疗.
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