[Therapeutic approaches to the severe type of acute pancreatitis]

The therapeutic problems of acute pancreatitis were discussed by analyzing data on 110 patients we experienced recently. The overall mortality was 8.2%. Of the severe cases classified by our assessment for the severity, 82.4% had undergone a surgical operation with the mortality 21.4%. Numerous, manifold pre-operative complications were recognized in 89.3% of the surgical treated severe cases. Each of the died cases had two or more of these complications. In order to improve the results of operative management for acute pancreatitis, the therapeutic approaches to severe pancreatitis were studied experimentally with necrotizing pancreatitis in dogs. Based on these experimental results, it was suggested that the effective results may be obtained by means of administering a protease inhibitor in inhibiting the activity of enzymes released from the pancreas, and a plasma exchange, a new therapeutic measure with the aim of directly removing harmful enzymes and toxic substances from inside the body. Then, finally, the surgical procedure of pancreatectomy should be applied to the affected tissue with the aim of eradicating the source for the release of the pancreatic enzymes.