[Study on combined therapy of hyperlipidemic severe acute pancreatitis].
OBJECTIVE
To investigate the principle and measures of combined treatment of the patients with hyperlipidemic severe acute pancreatitis (HL-SAP).


METHODS
The clinical data of 54 patients with HL-SAP including two phases from January 1996 to December 2000 and from January 2001 to August 2006 were analyzed retrospectively. In the first phase, 25 patients were performed by routine methods to decrease triglyceride, or additional operative treatments. In the second phase, 29 cases were treated by multiple ways of non-operative combined therapy, or additional operative treatments mainly by minimally invasive procedures.


RESULTS
Among 54 cases with HL-SAP, 33 cases (61.1%) received non-operative therapy and 21 cases (38.9%) received surgical intervention. Overall mortality was 18.5% (10/54). In the first phase of 25 cases, the mortality in non-operative group and surgical intervention group was 21.4% (3/14) and 36.3% (4/11), respectively. In the second phase of 29 cases, the mortality in non-operative group and surgical intervention group was 10.5% (2/19) and 10.0% (1/10), respectively. The overall curative rate, morbidity, overall mortality, content of triglyceride at the fourth day after onset, APACHE II score at the fourth day after onset and average stay were obviously improved in the second phase compared with the first phase (P < 0.05).


CONCLUSIONS
According to individualized therapy principles, treatment for HL-SAP should emphasis on multiple ways of non-operative combined therapy and appropriate choices of the timing, indication in surgical intervention. And the choice of operative procedure should follow the principle of minimally invasive surgery. Meanwhile, pay more attention to monitoring and controlling the level of triglyceride post-discharge for the patients with the history of HL-SAP.
Sun
Bei
B
Department of Hepatobiliary and Pancreatic Surgery, First Clinical Hospital of Harbin Medical University, Harbin 150001, China. sunbei70@tom.com
Xu
Dong-sheng
DS
Jiang
Hong-chi
HC
Tai
Sheng
S
Cui
Yun-fu
YF
Xu
Jun
J
Liu
Chang
C
Meng
Qing-hui
QH
Liu
Jie
J
Wu
Lin-feng
LF
D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications* / Q000628:therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies