腹腔镜胆囊切除术后早期急性胰腺炎的诊断与处理

Diagnosis and Treatment of Early-stage Acute Pancreatitis Following Laparoscopic Cholecystectomy

目的探讨腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)术后早期胰腺炎的临床特点及治疗措施。方法1998年4月～2006年6月,行LC18470例,术后早期(<14d)急性胰腺炎16例(0.09%)。对于无胆道梗阻的病例,采取综合保守治疗(胃肠减压、抗感染、应用生长抑素等);如明确有胆道梗阻,则行开腹胆总管探查术。结果14例保守治疗治愈,住院时间8～22d,平均12d;开腹手术2例。无围手术期死亡。16例随访5个月～3年,平均14个月,无胰腺炎、胆总管结石复发。结论LC术后在不恰当饮食等各种诱因作用下早期易并发以腹痛为主要表现的急性胰腺炎,多数经保守治疗可取得很好的效果。

Objective To investigate the clinical characteristics and treatments of early-stage acute pancreatitis following laparoscopic cholecystectomy （LC）. Methods From April 1998 to June 2006, totally 18 470 cases of LC were performed in our hospital, 16 （0.09%） of them developed early-stage acute pancreatitis （ 〈 14 days） after the surgery. We performed common bile duct exploration for the cases complicated with biliary tract obstruction, while for those without obstruction, conservative treatments including gastrointestinal decompression, administration of antibiotics and somatostatin were carried out. Results Among the cases, 14 patients were cured by conservative treatments. The mean hospital stay of these patients was 12 days （8 -22 days）. The other two patients received open surgery, none of them died during peri-operational period. The 16 patients were followed up for 5 months to 3 years （mean, 14 months） , no one of them had recurrence of pancreatitis or biliary stones. Conclusions Early-stage acute pancreatitis can be induced by improper diet or other factors after LC, showing abdominal pain as the main manifestation. Conservative treatments is effective for the disease.