微创治疗胆源性胰腺炎55例手术时机探讨

The method and timing of minimally invasive surgery in the treatment of gallstone pancreatitis

目的：探讨胆源性胰腺炎的微创治疗的方法及其时机。方法：对55例胆源性胰腺炎患者进行微创治疗,并与行开腹手术及药物保守治疗的132例胆源性胰腺炎患者进行对比分析。结果：采用急诊内镜下乳头切开（EST）＋取石＋ENBD治疗55例胆源性胰腺炎患者血淀粉酶恢复正常最快（5.4±2.5d）;而单纯药物保守治疗和急诊开腹胆囊切除＋胆总管切开取石＋胆道镜探查术的132例胆源性胰腺炎患者血淀粉酶恢复正常的时间最长（8.5~3.1d）。结论：胆源性胰腺炎的梗阻型ERCP治疗为首选;ENBD和EST＋网篮取石宜在发病的早期进行,最好是确诊后的48 h以内,72 h后不适宜采取;保守治疗后的手术时机,最好是在病情稳定后的3~4周。

Objective： To explore the methods and timing of minimally invasive surgery in the treatment of gallstone pancreatitis（GP）.Methods： The 55 cases that were treated with minimally invasive surgery treatment were compared with the 132 cases that were treated with open surgery and medication.Results：The recovery time of blood amylase was（5.4±2.5d） in 55 cases who underwent endoscopic sphincterotomy（EST）,stone removal and Endoscopic Nasobiliary Drainage（ENBD）.The recovery time of blood amylase was（8.5±3.1d） in 132 cases who underwent medication,gallbladder resection,laparoscopic choledocholithotomy and choledochoscopy.Conclusion：Endoscopic Retrograde Cholangio Pancreatography is the first treatment to GP of obstructive type.It is important to conduct the treatment of ENBD,EST and basket extraction with GP as soon as possible.The optimal treatment time should be within 48h,and should not be more than 72h.The reasonable operation timing is 3 or 4 weeks after the patients condition are stable for patients of medication.