腹腔镜胆囊切除术后并发胰腺炎的原因分析

Analysis and treatment for pancreatitis after laparoscopic cholecystectomy

目的分析腹腔镜胆囊切除术(LC)后并发胰腺炎的原因,并提出预防和处理措施。方法回顾性分析12例LC术后胰腺炎病例的临床资料,并总结其发病原因。结果12例胰腺炎的发病情况分别为:LC术后继发性胆总管结石5例;术后胆漏、腹腔感染诱发者1例;胆囊结石合并胆总管结石,分期行EST/ENBD术后胰腺炎2例;术前漏诊1例;隐匿性胰腺炎基础上的急性发作1例;原因不明2例。12例中的2例(1例继发性胆总管结石和1例腹腔感染)及时行剖腹手术,5例(4例继发性胆总管结石和1例胰腺炎漏诊者)行EST/ENBD,其余5例给予生长抑素为主的综合性保守治疗措施,12例均治愈。结论LC术后胰腺炎的主要原因与手术操作并发症有关(如继发性胆总管结石,EST/ENBD术后,胆漏、腹腔感染等);及早发现和正确处理,其预后均较佳;提高对其原因和发病机制的认识及对手术操作相关环节的重视是预防的关键。

[Objective] To analyze the reason and conclude the prevention and treatment countermeasures for the pancreatitis after laparoscopic cholecystectomy（LC）. [Method] The reason and possible mechanism for the 12 cases of pancreatitis after LC were analyzed retrospectively, and the reasonable prevention and treatment countermeasures for them were concluded. [Results] The inducements or reasons for the 12 cases of pancreatitis after LC were： secondary common bile duct （CBD） stone after LC （5 cases, A）; bile leakage and celiac infection （1 cases, B）; Staged EST/ENBD in 2 cases of gallbladder stone combined with CBD stone （C）; dropped diagnosis before LC （1 case, D）; and one case of acute outbreak on the basis of dormant pancreatitis （ E ） as well as 2 cases of unknown pancreatitis. All the cases were cured by open operation （1 case of A and B）, EST/ENBD （4 cases of A and 1 case of D） and comprehensive medication （Somatostatin as the key role） in the remaining 5 cases respectively. [Conclusion] If the early diagnosis and treatment are given, prognosis of pancreatitis mainly resulted from surgical manipulation after LC is ideal. Deep understanding the mechanism of this disease is the key for prevention.