2018 年第 7 期 第 13 卷

不同时机腹腔镜胆囊切除术治疗胆源性急性胰腺炎的临床效果

Clinical effect of different operation occasions of laparoscopic cholecystectomy on biliary acute pancreatitis

作者：潘登

英文作者：

单位：044000山西省运城市中心医院肝胆外科

英文单位：

关键词：胆源性急性胰腺炎；腹腔镜手术；手术时机

英文关键词：

• 摘要：

• 【摘要】目的    探讨不同时机腹腔镜胆囊切除术治疗胆源性急性胰腺炎的临床效果。方法    选择山西省运城市中心医院2015年1月1日至2016年12月31日收治的147例胆源性急性胰腺炎（AP）患者为研究对象，根据病情严重程度分轻症急性胰腺炎（MAP）、中-重症急性胰腺炎（MSAP）和重症急性胰腺炎（SAP）。根据不同手术时间将所有患者分为A1组（48例，发病72 h内手术）、A2组（37例，发病72 h～<1周手术）、B1组（34例，发病1～2周手术）和B2组（28例，发病2周后手术），其中MAP和MSAP归入A1组和A2组（共85例），SAP患者归入B1组和B2组（共62例）。比较各组患者术中出血量、手术时间、住院时间、住院费用，手术前及手术后3 d、7 d血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素水平，术后并发症（如肺部感染和切口感染）发生率和胰腺炎复发率的差异。结果    B1组、B2组患者术中出血量、手术时间、住院时间和住院费用均明显大于/长于/高于A1组、A2组［（46±4）、（47±6）ml比（32±4）、（33±4）ml，（51±4）、（53±4）min比（34±4）、（35±2）min，（42±5）、（36±5）d比（10±3）、（21±5）d，（8.5±1.4）、（6.9±1.3）万元比（2.6±0.4）、（3.9±0.5）万元］，差异均有统计学意义（均P＜0.05）。A2组住院时间和住院费用明显长于/高于A1组，而B2组住院时间和住院费用明显短于/低于B1组，差异均有统计学意义（均P＜0.05）。术后3 d、7 d各组患者血清ALT、AST和总胆红素均明显低于术前(均P<0.05)，而各组间差异无统计学意义（P＞0.05）。各组间总体术后肺部感染、切口感染发生率差异均无统计学意义（均P＞0.05），B2组复发率低于B1组，差异有统计学意义（P＜0.05）。结论    对于轻症胆源性AP患者在发病72 h内手术效果较好，而重症胰腺炎宜在发病2周后手术治疗。

• 【Abstract】Objective    To investigate the clinical effect of different operation occasions of laparoscopic cholecystectomy on biliary acute pancreatitis. Methods    Totally 147 cases of biliary acute pancreatitis（AP） admitted at Yuncheng Central Hospital from January 1st 2015 to December 31st 2016 were enrolled. According to the severity of disease, they were divided into mild acute pancreatitis（MAP）, mild to severe acute pancreatitis（MSAP） and severe acute pancreatitis（SAP）. According to the onset to operation time, the patients were divided into group A1（＜72 h, n=48）, group A2（72 h-<1 week, n=37）, group B1（72 h-2 weeks, n=34） and group B2（＞2 weeks, n=28）; patients with MAP and MSAP belonged to group A1 and A2（n=85）; patients with SAP belonged to group B1 and B2（n=62）. Intraoperative blood loss volume, operation time, hospital stay time, medical expense, levels of alanine aminotransferase(ALT), aspartate aminotransferase (AST) and total bilirubin(TBIL) before and 3, 7 d after operation, incidences of postoperative complications(pulmonary infection and incision infection) and recurrence of pancreatitis were analyzed. Results    Intraoperative blood loss volume, operation time, hospital stay time and medical expense in group B1 and B2 were significantly more/longer/higher than those in group A1 and A2［（46±4）,（47±6）ml vs （32±4）,（33±4）ml; （51±4）,（53±4）min vs （34±4）,（35±2）min; （42±5）,（36±5）d vs （10±3）,（21±5）d; （8.5±1.4）,（6.9±1.3）ten thousand yuan vs （2.6±0.4）,（3.9±0.5）ten thousand yuan］(P＜0.05). Hospital stay time and medical expense in group A2 were significantly longer/higher than those in group A1; hospital stay time and medical expense in group B2 were significantly shorter/lower than those in group B1(P＜0.05). Levels of ALT, AST and TBIL 3, 7 d after operation were significantly lower than those before operation(P＜0.05); there were no significant differences of ALT, AST and TBIL level among groups(P＞0.05). There were no significant differences of postoperative pulmonary infection rate and incision infection rate among groups(P＞0.05). Recurrence rate of pancreatitis in group B2 was significantly lower than that in group B1(P＜0.05). Conclusion    Mild biliary AP patients should be operated within 72 h after onset; severe biliary AP patients should be operated 2 weeks after onset.

  【Key words】Biliary acute pancreatitis;Laparoscopic operation;Timing of operation