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目的：重新评估重症急性胰腺炎（ＳＡＰ）的手术指征和手术方法。资料和方法：将本院１９９２年３月～１９９７年１０月手术治疗的ＳＡＰ患者３４例分成３组：第１组（组１）１２例，手术指征和手术方法与以往相同；第２组（组２）１４例，１０例仅作了胆囊切除；第３组（组３）８例，系中转手术或外院手术后转入病例。结果：组１与组２比较死亡率有显著性差异（Ｐ＜０．０５），并发症记分、住院时间有高度显著性差异（Ｐ＜０．００１）。组２治疗效果明显优于组１，这与组２多数病例仅作了胆囊切除有关。组３因部分病人发病４８ｈ内病情不详未参与比较。结论：ＳＡＰ的手术指征应为：（１）证实有胰腺感染或胰腺脓肿者；（２）经非手术治疗症状不缓解及短期内出现巨大假性囊肿者；（３）需要剖腹探查鉴别者。改善胰周感染或脓肿手术疗效的关键是提高早期诊断水平。对于急症手术时发现为ＳＡＰ者，以仅作单纯切除胆囊为最佳选择。
OBJECTIVE: To reassess the surgical indications and surgical procedures for severe acute pancreatitis (SAP). Materials and Methods: 34 patients with SAP treated surgically from March 1992 to October 1997 were divided into 3 groups: group 1 (group 1), 12 patients, the surgical indications and surgical methods were the same as before; Group 2 (Group 2) 14 cases, 10 cases were only cholecystectomy; Group 3 (group 3) 8 cases, Department of transfer surgery or outside the hospital after surgery into the case. Results: There was a significant difference (P <0.05) in mortality between group 1 and group 2, and a highly significant difference in complication scores and hospitalization time (P <0.001). Group 2 treatment was significantly better than group 1, which was the only group 2 with cholecystectomy. Group 3 due to some patients within 48h of onset of disease is not involved in the comparison. Conclusions: SAP indications for surgery should be: (1) confirmed pancreatic infection or pancreatic abscess; (2) non-surgical treatment of symptoms did not alleviate and short-term emergence of a huge pseudocyst; (3) requires laparotomy identification . The key to improving the efficacy of pancreatic infection or abscess surgery is to improve the level of early diagnosis. For emergency surgery was found for SAP, only for simple removal of the gallbladder for the best choice.