摘要
目的研究轻症胆源性胰腺炎早期行腹腔镜联合胆道镜保胆取石术的疗效。方法回顾分析2014年1月至2017年5月保定市第二医院胆囊结石合并轻症胆源性胰腺炎患者93例,其中行保胆取石术51例,早期保胆组32例、延期保胆组19例,腹腔镜胆囊切除组22例,保守治疗组20例。早期保胆组及胆囊切除组经保守治疗后7~10 d内分别行保胆取石术及腹腔镜胆囊切除术,延期保胆组保守治疗6周后再次入院行保胆取石术,4组临床资料作对照研究。结果手术组均获得成功,保守治疗组胰腺炎复发率明显高于其余3组(P<0.05)。早期保胆组、延期保胆组与胆囊切除组术后血清淀粉酶未有明显升高,术后第7天丙氨酸转氨酶、天冬氨酸转氨酶比较差异无统计学意义(P>0.05),保胆组在手术时间、术中出血量、术后并发症方面明显优于胆囊切除组(P<0.05),早期保胆组比延期保胆组住院时间明显缩短(P<0.05)。结论轻症胆源性胰腺炎可先行保守治疗,待临床症状缓解后对胆囊收缩功能良好的患者早期(7~10 d)行保胆取石术是安全可行的。
Objective To investigate the therapeutic effect of laparoscopic choledochoscopy assisted removal of cholecystolithotomy( LRCL) on the early lines of mild acute biliary pancreatitis( ABP). Methods The data of93 cases of gallstone with ABP in our hospital between Jan 2014 to May 2017 were retrospectively reviewed. 51 cases underwent LRCL,32 cases in early group,19 cases in delayed group,22 cases in LC group and 20 caeses inconservative treatment group. All patients underwent conventional treatment first,after 7 to 10 days the early group underwent LRCL and LC group underwent LC,the delayed group underwent LRCL when readmissionafter6 weeks,and the results were compared. Results All the operation were successful, conservative treatment group of postoperative recurrent pancreatitis recurrence rate was high than other groups( P < 0. 05). Compared aspertate aminotransferased and cereal third transaminase there were no statistically difference between early group,delayed group and LC group( P > 0. 05). Gall bladder calculi recurrence rate was no statistically difference in early and delayed group. LRCL group were significantly superior in to LC group operationtime,intraoperative blood loss,postoperative complications( P < 0. 05),the hospitalization time in the early group was significantly shorter than that in the delayed group. Conclusion Acute biliary pancreatitis can be treated conservatively,and LRCL is safe and feasible for patients who have good gallbladder systolic function at early( 7 ~ 10 d) after the clinical symptoms have been relieved.
出处
《医学研究与教育》
CAS
2017年第5期7-13,28,共8页
Medical Research and Education
关键词
胆囊结石
保胆取石术
胆源性胰腺炎
gallstone
laparoscopic-choledochoscopy-assisted removal of cholecystolithotomy
acute biliary pan creatitis
作者简介
第一作者：张晓强（1986-）,男,山东潍坊人,医师,在读硕士,主要从事肝胆外科研究.E-mail：1091998911@qq.com
