摘要
目的探讨应用腹腔镜胆总管探查术(LCBDE)+腹腔镜胆囊切除术(LC)与内镜逆行胰胆管造影(ERCP)/内镜下十二指肠乳头括约肌切开术(EST)+LC治疗胆囊结石并胆总管结石的胆源性轻症急性胰腺炎的疗效及安全性。方法将我院2015年1月~2019年6月收治的276例胆囊结石并胆总管结石的胆源性轻症急性胰腺炎的患者按治疗方案随机分为两组:LCBDE+LC组及ERCP/EST+LC组。比较两组手术时间、术中出血量、完全取石率、中转开腹率、术后排气时间、下床时间、住院费用、住院时间、总胆红素、丙氨酰氨基转移酶、天门冬氨酸氨基转移酶、血淀粉酶的变化趋势及并发症发生率。结果与LCBDE+LC组相比,ERCP/EST+LC组手术时间和术中出血量、术后排气时间、下床时间和胆瘘发生率显著性减少;而住院费用和重症急性胰腺炎发生率显著性增加;两组住院时间、完全取石率、中转开腹率、术后总胆红素、丙氨酰氨基转移酶、天门冬氨酸氨基转移酶、血淀粉酶、消化道穿孔和腹腔感染的发生率比较差异无统计学意义(P>0.05)。结论早期应用LCBDE+LC组与ERCP/EST+LC组均能有效治疗胆囊结石并胆总管结石的胆源性轻症急性胰腺炎,具体实施应根据患者实际病情及医院条件,个性化选择最合适的微创治疗方式。
Objective To explore the efficacy and safety of laparoscopic common bile duct exploration(LCBDE)+laparoscopic cholecystectomy(LC)and endoscopic retrograde cholangiopancreatography(ERCP)/endoscopic sphincterotomy(EST)+LC in the treatment of mild biliary acute pancreatitis induced by gallstones complicated with common bile duct stones.Methods 276 patients with mild biliary acute pancreatitis induced by gallstones complicated with common bile duct stones who were admitted in our hospital from January 2015 to June 2019 were randomly divided into two groups according to the treatment plan:LCBDE+LC group and ERCP/EST+LC group.The surgery time,intraoperative blood loss,complete stone removal rate,transfer laparotomy rate,postoperative exhaust time,time to get out of bed,hospitalization cost,length of hospital stay,total bilirubin,alanyl aminotransferase,aspartate aminotransferase,blood amylase change trends and the incidence rate of complications were compared between the two groups.Results Compared with the LCBDE+LC group,the surgery time,intraoperative blood loss,postoperative exhaust time,time to get out of bed and the incidence of biliary leakage were significantly less than those in the ERCP/EST+LC group;the hospitalization costs and the incidence rate of severe acute pancreatitis were increased significantly;there were no statistically significant differences in the length of hospital stay,complete stone removal rate,transfer laparotomy rate,postoperative total bilirubin,alanyl aminotransferase,aspartate amino transferase,blood amylase,digestive tract perforation and the incidence rate of abdominal infection between the two groups(P>0.05).Conclusion Early application of LCBDE+LC group and ERCP/EST+LC group can effectively treat mild biliary acute pancreatitis induced by gallstones complicated with common bile duct stones.The specific implementation should be based on the patient's actual conditions and hospital conditions to carry out personalized selection of the most appropriate minimally invasive treatment.
作者
林秋满
王桂良
肖归
龚敏
邱萍
徐林芳
刘星
文剑波
LIN Qiuman;WANG Guiliang;XIAO Gui;GONG Min;QIU Ping;XU Linfang;LIU Xing;WEN Jianbo(Pingxiang Hospital of Southern Medical University,Pingxiang 337000,China;School of Nursing,Hainan Medical University,Haikou 571199,China)
出处
《中国现代医生》
2020年第20期5-9,共5页
China Modern Doctor
基金
国家自然科学基金项目(81360080)。
关键词
胆囊结石
胆总管结石
腹腔镜胆总管探查术
内镜逆行胰胆管造影
急性胰腺炎
Gallstones
Common bile duct stones
Laparoscopic common bile duct exploration(LCBDE)
Endoscopic retrograde cholangiopancreatography(ERCP)
Acute pancreatitis
