Abstract: To explore non-operative methods and the opportunity of operative in patients with severe acute pancreatitis (SAP), 223 patients with SAP were treated in our ICU from 1990 to 1999. Non operative methods included fluid resuscitation, reduction of pancreatic secretion, elimination of inflammation mediators, supportive measures and close supervision, nutritional support, prevention and treatment of infections etc. Indication for operation in patients was pancreatic infection from 1990 to 1994.Aggressive debridement with placement of several drains into lesser sac for the purpose of continuous lavage was performed on the patient of the infectious pancreatic necrosis or fluid collection. The drainage of pancreatic abscess or localized infection with debridement of necrotic tissues was adopted from 1995 to 1999. Twenty-three patients underwent operations due to pancreatic infection during the treatment. The postoperative mortality rate of pancreatic abscess or localized infection was lower than that of infectious pancreatic necrosis or fluid collection. Active ,effective and comprehensive non operative treatment is the basic treatment of SAP. The operation of pancreatic abscess or localized infection is more effective than that of unlocalized pancreatic infection.

Key words: pancreatitis, infection, combined modality therapy