腹腔镜胆囊切除术治疗胆源性胰腺炎的时机分析
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摘要
目的 :研究腹腔镜胆囊切除术治疗胆源性胰腺炎的手术时机。方法 :选取我院2013年5月～2016年5月64例胆源性胰腺炎患者为研究对象,根据手术时机将纳入患者分为早期组(n=32)与延期组(n=32),早期组在发病7d内行腹腔镜胆囊切除术,延期组在发病7d后再行腹腔镜胆囊切除术。比较两组手术疗效、术中与术后指标、实验室指标、并发症发生率。结果 :早期组术后6个月复发率、总住院时间、血淀粉酶、尿淀粉酶分别为0.0%、(9.49±2.45)d、(142.64±72.57)IU/L、(1254.36±457.15)IU/L显著低于延期组的11.8%、(13.21±4.38)d、(194.51±108.32)IU/L、(1518.49±522.08)IU/L。结论 :发病7d内施行腹腔镜胆囊切除术可以尽早解除胆道梗阻,恢复胆汁、胰液引流通畅,控制胰腺炎病情发展,有利于患者术后康复。
Objective To study the timing of laparoscopic cholecystectomy for biliary pancreatitis. Methods A total of 64 patients with biliary pancreatitis who were admitted to the hospital between May 2013 and May 2016 were selected as the study subjects. According to the timing of operation, the patients were divided into the early group(n=32) and delayed group(n=32). The early group were treated with laparoscopic cholecystectomy within 7 d after onsetwhile the delayed group were treated at 7 d after onset. The operative effect, intraoperative and postoperative indexes, laboratory indexes and the incidence rate of complications were compared between the two groups. Results The recurrence rate, the total length of hospital stay, blood amylase and urine amylase levels in the early group in 6 months after operation [0.0%,(9.49±2.45) d,(142.64±72.57) IU/L,(1254.36±457.15) IU/L] were significantly lower than those in the delayed group [11.8%,(13.21±4.38) d,(194.51±108.32) IU/L,(1518.49 + 522.08) IU/L]. Conclusion The implementation of laparoscopic cholecystectomy within 7 d after onset can relieve biliary obstruction as soon as possible, restore bile and pancreatic juice drainage and control the development of pancreatitis. It is conducive to the rehabilitation of patients after operation.
Objective To study the timing of laparoscopic cholecystectomy for biliary pancreatitis. Methods A total of 64 patients with biliary pancreatitis who were admitted to the hospital between May 2013 and May 2016 were selected as the study subjects. According to the timing of operation, the patients were divided into the early group(n=32) and delayed group(n=32). The early group were treated with laparoscopic cholecystectomy within 7 d after onsetwhile the delayed group were treated at 7 d after onset. The operative effect, intraoperative and postoperative indexes, laboratory indexes and the incidence rate of complications were compared between the two groups. Results The recurrence rate, the total length of hospital stay, blood amylase and urine amylase levels in the early group in 6 months after operation [0.0%,(9.49±2.45) d,(142.64±72.57) IU/L,(1254.36±457.15) IU/L] were significantly lower than those in the delayed group [11.8%,(13.21±4.38) d,(194.51±108.32) IU/L,(1518.49 + 522.08) IU/L]. Conclusion The implementation of laparoscopic cholecystectomy within 7 d after onset can relieve biliary obstruction as soon as possible, restore bile and pancreatic juice drainage and control the development of pancreatitis. It is conducive to the rehabilitation of patients after operation.
引文
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[5]许明亮,曹安华,李刚.四孔法腹腔镜胆囊切除术与传统开腹胆囊切除术的临床疗效比较[J].湖南师范大学学报(医学版), 2016,13(3):85-88.
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[8]陈胜,吴卫泽,李能平.轻症急性胆源性胰腺炎腹腔镜胆囊切除手术时机的探讨[J].中华胰腺病杂志, 2016, 16(5):326-330.
[9]赵晖,竺来法,曹文玺,等.早期腹腔镜胆囊切除术在急性胆源性胰腺炎中的应用[J].肝胆胰外科杂志, 2016, 28(2):102-104.
[10]马万里,王晨宇,杨志家,等.不同手术时机在LC联合EST治疗轻型急性胆源性胰腺炎中的疗效比较[J].广西医学, 2014, 36(2):253-255.
[2]汤亲青,方茂勇.41例急性胆源性胰腺炎行腹腔镜胆囊切除术与胆囊切除术疗效分析和手术时机体会[J].肝胆外科杂志, 2015, 23(3):176-178.
[3]中华医学会消化病学分会胰腺疾病学组.中国急性胰腺炎诊治指南(2013年,上海)[J].中华消化杂志, 2013, 33(4):530-535.
[4]康晓文,洪万东,黄庆科,等.老年复发性胆源性急性胰腺炎诊治体会[J].临床误诊误治, 2015, 28(2):13-14.
[5]许明亮,曹安华,李刚.四孔法腹腔镜胆囊切除术与传统开腹胆囊切除术的临床疗效比较[J].湖南师范大学学报(医学版), 2016,13(3):85-88.
[6]罗鹏,唐歆馨.急性复发性胰腺炎临床治疗分析[J].湖南师范大学学报医学版, 2012, 9(2):47-50.
[7]胡文江,王燕鹏,刘军.急性胆源性胰腺炎早期手术治疗的临床体会[J].国际外科学杂志, 2015, 42(6):379-382.
[8]陈胜,吴卫泽,李能平.轻症急性胆源性胰腺炎腹腔镜胆囊切除手术时机的探讨[J].中华胰腺病杂志, 2016, 16(5):326-330.
[9]赵晖,竺来法,曹文玺,等.早期腹腔镜胆囊切除术在急性胆源性胰腺炎中的应用[J].肝胆胰外科杂志, 2016, 28(2):102-104.
[10]马万里,王晨宇,杨志家,等.不同手术时机在LC联合EST治疗轻型急性胆源性胰腺炎中的疗效比较[J].广西医学, 2014, 36(2):253-255.