目的 探讨因胆囊结石而导致的轻症型急性胆源性胰腺炎(mild acute biliary pancreatitis,MABP)行腹腔镜胆囊切除术的手术时机。方法 回顾性分析山西医科大学第一医院2016-01至2018-06收治的150例MABP患者。所选择病例均行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),根据患者住院后手术时间将MABP患者分为3组,A组为急诊手术组(10例,发病72 h内手术),B组为早期手术组(50例,手术时间72 h~2周完成),C组为延期手术组(90例,手术时间＞2周)。比较各组术中的出血总量、手术时间、住院时间和费用,各项生化指标,如术前及术后3 d血清丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素水平等,围术期并发症发生率(如切口感染),转归(如治愈率、复发率等)。结果 C组的住院时间[36(34,37)d]最长、住院费用[7.6(7.4,7.7)万元]最高,A组的住院时间[15(14,16)d]最短、住院费用[3.6(3.4,3.73)万元]最低,差异有统计学意义(P<0.05)。3组患者的手术时间分别是[(48.08±7.52)min、(61.16±6.35)min和(74.86±8.68)min],组间差异有统计学意义(P<0.05);但3组患者的术中总出血量差异无统计学意义。各组患者术后AST、ALT、总胆红素、血淀粉酶、脂肪酶、血糖、白细胞等均低于术前,血钙高于术前,3组患者术后AST和ALT相比差异有统计学意义(P<0.05),3组之间其余血液生化指标差异均无统计学意义。各组间围术期并发症发生率差异无统计学意义,3组复发率比较差异无统计学意义。结论 MABP患者应该选择在发病72 h内行LC较好。
Abstract
Objective To investigate the best timing of laparoscopic cholecystectomy for mild acute gallstone pancreatitis.Methods Totally 150 cases of mild acute biliary pancreatitis(MABP) admitted to the First Hospital of Shanxi Medical University between January 1, 2016 to June 30, 2018 were enrolled.All these cases underwent laparoscopic cholecystectomy(LC). According to the time of start of surgery,the patients were divided into three groups: group A (emergency operation)(＜72 h, n=10),group B (early operation) (72 h-2 weeks, n=50) and group C (deferred operation)(＞2 weeks, n=90). The intraoperative blood loss volume,duration of surgery,length of hospital stay, medical expense,such biochemical indexes as levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin (TBIL)before operation and 3d after operation,the incidence of postoperative complications(pseudocyst and pancreatic abscess), recovery and recurrence of pancreatitis were analyzed.Results Group C had the longest hospital stay[36(34,37)d] and the highest medical expense[76,000(74,000 and 77,000)yuan], while group A had the shortest hospital stay[15(14,16)d] and the minimum medical expense[36,000(34,000 and 37,300)yuan], The duration of surgery of the three groups was[(48.08±7.52)min,(61.16±6.35)min and(74.86±8.68)min respectively](P<0.05).Levels of ALT,AST,TBIL,amylase, lipase, blood glucose and hemameba decreased significantly 3 d after operation, but the level of blood calcium was higher than before(P<0.05). There was significant difference in levels of ALT and AST 3 d after operation between these groups (P<0.05). but there was no significant difference in the incidence of postoperative complications or the rate of recurrence between these groups.Conclusions Mild biliary AP patients should be operated on within 72 hours of onset.
关键词
胆源性胰腺炎 /
腹腔镜胆囊切除术 /
手术时机
Key words
acute biliary pancreatitis /
laparoscopic cholecystectomy /
timing of operation
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