胆囊结石伴急性胰腺炎的腹腔镜胆囊切除术

Laparoscopic cholecystectomy for acute pancreatitis accompanying gallstones

目的探讨胆囊结石伴急性胰腺炎实施腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）的可行性及手术时机。方法回顾性分析我院1999年1月-2003年8月行LC治疗胆囊结石伴急性胰腺炎21例的临床资料。结果2l例均在急性胰腺炎发作后20—40d，血、尿淀粉酶正常15d后，成功实施LC，9例放置腹腔引流管。术后19例恢复顺利，当日或次日下床活动，12h后进食，术后24—72h拔除腹腔引流管，无并发症。2例术后3d又发作急性胰腺炎，经保守治疗后症状缓解。住院4—20d，平均7d。21例随访6个月一5年，平均19个月，均无复发。结论对胆囊结石伴急性胰腺炎患者在急性胰腺炎发作后20—40d，如能慎重选择病例，做好必要的围手术处理，术中仔细操作，术后适当引流，实施LC是安全的。

Objective To investigate the feasibility and timing of laparoscopic cholecystectomy （LC） for the treatment of acute pancreatitis accompanying gallstones. Methods A retrospective analysis was made on clinical data of 21 patients with acute pancreatitis accompanying gallstones treated by LC between January 1999 and August 2003 in this hospital. Results The LC was performed 20 - 40 days after the onset of pancreatitis and 15 days after the recovery of serum and urinary amylase levels. An abdominal drainage tube was placed in 9 patients. Postoperative recovery was uneventful in 19 patients, who got out of bed on the surgery day or on the first postoperative day and began to take food 12 hours after operation, with the abdominal drainage tube removed 24 - 72 hours postoperatively and no complications encountered. Recurrence of acute pancreatitis happened in 2 patients on the 3 postoperative days and was relieved from symptoms with conservative treatment. The duration of postoperative hospital stay was 4 - 20 days （ mean, 7 days）. Follow-up checkups in the 21 patients for 6 months - 5 years （mean, 19 months） found no recurrence. Conclusions Laparoscopic eholecystectomy is feasible and safe for patients with acute pancreatitis accompanying gallstones in the period of 20 - 40 days after the onset of pancreatitis. Careful patient selection, proper peri-operative treatment, strict adherence to techniques, and use of postoperative drainage are considered essential.