目的探讨重型非胆道梗阻性急性胆石性胰腺炎的外科处理要点。方法分析47例重型非胆道梗阻性急性胆石性胰腺炎病人的临床资料。结果(1)1999年8月以前,13例采用早期手术,4例死于早期多脏器功能衰竭,病死率为30.8%;存活者平均住院时间为51.5d、平均医疗费用为9.53万元。(2)1999年8月以后,22例采用早期区域动脉灌注治疗,1例死于后期感染并发症,病死率为4.5%;存活者平均住院时间为31.3d,平均医疗费用为4.64万元。(3)12例采用传统保守治疗,4例病情较重者3例死于早期多脏器功能障碍;其余8例病情较轻者无并发症治愈。结论(1)在急性反应期内,作好复苏治疗的同时,推荐应用区域动脉灌注治疗重型非梗阻性胆石性胰腺炎;(2)重视临床类型的鉴别和转化,发现胆道梗阻及时手术治疗;(3)病变后期出现胰腺局部并发症需要适时的择期手术;(4)非手术治疗成功者应适时手术解除胆石病变以防止胰腺炎复发。 Objective To investigate the surgical treatment of severe non-biliary obstructive acute gallstone pancreatitis. Methods The clinical data of 47 patients with severe non-biliary obstructive acute gallstone pancreatitis were analyzed. Results (1) Before August 1999, 13 cases were treated by early surgery and 4 cases died of early multiple organ failure with a mortality rate of 30.8%. The average length of hospital stay was 51.5 days and the average medical cost was 95,300 yuan. (2) After August 1999, 22 cases were treated with arterial infusion in the early stage and 1 case died of late infection. The case fatality rate was 4.5%. The average length of hospital stay was 31.3 days and the average medical cost was 46,400 yuan. (3) Twelve cases were treated conservatively, and 4 cases of serious illness died of early multiple organ dysfunction. The remaining 8 cases were cured without complication. Conclusions (1) In the acute reaction period, while resuscitation therapy is recommended, regional arterial infusion recommended for the treatment of severe non-obstructive gallstone pancreatitis; (2) to pay attention to the identification and transformation of clinical types and found that timely surgical treatment of biliary obstruction; (3) pancreatic complications occur late stage of the disease requires timely elective surgery; (4) non-surgical treatment should be timely surgery to relieve gallstone disease to prevent the recurrence of pancreatitis.