急性胆源性胰腺炎患者行腹腔镜胆囊切除手术时机选择探讨
| 作者: |
1宋兴超,
1吴磊,
1路要武
1 江苏省徐州市第一人民医院 普通外科，江苏 徐州 221002 |
| 通讯: |
宋兴超
Email: m13905229772@163.com |
| DOI: | 10.3978/.2018.03.013 |
摘要
目的：探讨急性胆源性胰腺炎（ABP）患者行腹腔镜胆囊切除手术时机选择。
方法：选择2014年3月—2017年1月收治的96例ABP患者，其中47例在行腹腔镜胆囊切除术与胆总管探查术之前行保守治疗，49例直接行腹腔镜胆囊切除术与胆总管探查术（对照组）。比较两组患者的相关临床指标。
结果：与对照组比较，观察组的术后镇痛药使用例数（19例vs. 9例）、平均手术时间（1.9 h vs. 1.6 h）、平均术后胃肠蠕动恢复时间（2.6 d vs. 1.9 d）、术后切口感染例数（7例vs. 1例）、中转开腹手术例数（6例vs. 1例）、平均术后引流量（56.9 mL vs. 32.4 mL）与平均术后住院时间（6.2 d vs. 4.5 d）均明显减少，治疗总有效率（81.6% vs. 95.7%）明显升高（均P<0.05）。随访期9~39个月，两组均无ABP复发。
结论：ABP先行积极保守治疗，待胰腺炎缓解后，再行腹腔镜胆囊切除，具有安全可行的特点，推荐临床应用。
关键词：
胰腺炎；胰腺管；保守治疗；胆囊切除术，腹腔镜
方法：选择2014年3月—2017年1月收治的96例ABP患者，其中47例在行腹腔镜胆囊切除术与胆总管探查术之前行保守治疗，49例直接行腹腔镜胆囊切除术与胆总管探查术（对照组）。比较两组患者的相关临床指标。
结果：与对照组比较，观察组的术后镇痛药使用例数（19例vs. 9例）、平均手术时间（1.9 h vs. 1.6 h）、平均术后胃肠蠕动恢复时间（2.6 d vs. 1.9 d）、术后切口感染例数（7例vs. 1例）、中转开腹手术例数（6例vs. 1例）、平均术后引流量（56.9 mL vs. 32.4 mL）与平均术后住院时间（6.2 d vs. 4.5 d）均明显减少，治疗总有效率（81.6% vs. 95.7%）明显升高（均P<0.05）。随访期9~39个月，两组均无ABP复发。
结论：ABP先行积极保守治疗，待胰腺炎缓解后，再行腹腔镜胆囊切除，具有安全可行的特点，推荐临床应用。
Study of timing for laparoscopic cholecystectomy in patients with acute biliary pancreatitis
CorrespondingAuthor:SONG Xingchao Email: m13905229772@163.com
Abstract
Objective: To investigate the selection of timing for laparoscopic cholecystectomy in patients with acute biliary pancreatitis (ABP).
Methods: Ninety-six ABP patients admitted during March 2014 to January 2017 were enrolled. Of the patients, 47 cases underwent conservative treatment before laparoscopic cholecystectomy and common bile duct exploration (observation group), and 49 cases were subjected to laparoscopic cholecystectomy and common bile duct exploration directly (control group). The main clinical variables between the two groups of patients were compared.
Results: In observation group compared with control group, the number of cases requiring postoperative analgesics (19 cases vs. 9 cases), average operative time (1.9 h vs.1.6 h), average time to postoperative recovery of peristalsis (2.6 d vs.1.9 d), number of cases with postoperative wound infection (7 cases vs.1 case), number of cases requiring open conversion (6 cases vs.1 case), average volume of postoperative drainage (56.9 mL vs. 32.4 mL), and average length of postoperative hospital stay (6.2 d vs. 4.5 d) were reduced and overall treatment effective rate (81.6% vs. 95.7%) was increased significantly (all P<0.05). Follow-up was conducted for 9 to 39 months, and repeated ABP was noted.
Conclusion: For ABP, administering conservative treatment first until pancreatitis subsides prior to laparoscopic cholecystectomy is safe and feasible, and it is recommended to be used in clinical practice.
Keywords：
Pancreatitis; Pancreatic Ducts; Conservative Treatment; Cholecystectomy
Laparoscopic
Methods: Ninety-six ABP patients admitted during March 2014 to January 2017 were enrolled. Of the patients, 47 cases underwent conservative treatment before laparoscopic cholecystectomy and common bile duct exploration (observation group), and 49 cases were subjected to laparoscopic cholecystectomy and common bile duct exploration directly (control group). The main clinical variables between the two groups of patients were compared.
Results: In observation group compared with control group, the number of cases requiring postoperative analgesics (19 cases vs. 9 cases), average operative time (1.9 h vs.1.6 h), average time to postoperative recovery of peristalsis (2.6 d vs.1.9 d), number of cases with postoperative wound infection (7 cases vs.1 case), number of cases requiring open conversion (6 cases vs.1 case), average volume of postoperative drainage (56.9 mL vs. 32.4 mL), and average length of postoperative hospital stay (6.2 d vs. 4.5 d) were reduced and overall treatment effective rate (81.6% vs. 95.7%) was increased significantly (all P<0.05). Follow-up was conducted for 9 to 39 months, and repeated ABP was noted.
Conclusion: For ABP, administering conservative treatment first until pancreatitis subsides prior to laparoscopic cholecystectomy is safe and feasible, and it is recommended to be used in clinical practice.