梗阻型胆源性胰腺炎的微创治疗

Minimally invasive treatment for obstructive biliary pancreatitis

目的探讨梗阻型胆源性胰腺炎的微创治疗方式与效果。方法对42例梗阻型胆源性胰腺炎患者采用4种不同的微创治疗方法,并对治疗结果进行评价。结果 29例患者行急诊内镜治疗,其中17例急诊内镜下未能完全去除梗阻因素或合并有胆囊结石、肝内胆管结石,于急性胰腺炎缓解后2-4周行二期内镜治疗或腹腔镜手术;13例行急诊腹腔镜手术,8例残余肝内外胆管结石,于术后2周行二期内镜或6-8周行胆道镜检查取石。本组无死亡病例,无消化道出血及穿孔等内镜操作相关并发症。腹腔镜手术无中转开腹,术后出现胆漏2例、胸腔积液4例,肺部感染3例,均经保守治疗痊愈。随访6个月-3年,未见胰腺炎复发。结论内镜和腹腔镜技术的单独或联合应用是治疗梗阻型胆源性胰腺炎的有效微创手段,可在临床推广应用。

Objective To investigate the minimally invasive treatment for obstructive biliary pancreatitis.Methods The clinical data of 42 patients with acute obstructive biliary pancreatitis were retrospectively analyzed.Results 29 cases received emergency endoscopic therapy,among them,the second-stage endoscopic or laparoscopic treatment were performed in 17 cases because of obstructive factor or stones.13 cases underwent emergency laparoscopic procedures.Due to residual stones,8 cases were performed second-stage endoscopic or choledochoscope treatment.No death occurred in our group.There were no endoscope related severe complications or aggravated symptoms.No cases converted to laparotomy.Postoperative complications,including bile leakage in 2 cases,pleural effusion in 4,lung infection in 3,were cured.In 6-36 month follow-up,there were no recurrent pancreatitis.Conclusion Early endoscopic or/and laparoscopic therapy is a safe and effective minimal method for acute obstructive biliary pancreatitis and has its clinical application value.