十二指肠镜和腹腔镜治疗急性胆源性胰腺炎的临床疗效比较

Clinical effectiveness of duodenoscope vs. laparoscope for acute biliary pancreatitis

目的比较十二指肠镜和腹腔镜在急性胆源性胰腺炎治疗中的临床疗效。方法将89例急性胆源性胰腺炎病人随机分为十二指肠镜组（45例）和腹腔镜组（44例），在发病72h之内应用上述2种方法处理，比较2组手术前后WBC、总胆红素（TBIL）、丙氨酸转氨酶（ALT）、血淀粉酶（BAMS）和白细胞介素10（IL-10）水平的变化和术后胆道感染发生率。结果两组血清WBC、TBIL、ALT、BAMS和IL-10的水平在术后第3天均开始下降，且均显著低于术前水平，差异均有统计学意义（P〈0．05）。WBC在术后第3天下降程度，腹腔镜组大于十二指肠镜组，差异有统计学意义（P〈0．05）；而BAMS在术后第3天下降程度，十二指肠镜组大于腹腔镜组，差异有统计学意义（P〈0．05）。十二指肠镜组胆道感染发生率（17．8％）显著高于腹腔镜组（2．3％），差异有统计学意义P〈0．05）。结论十二指肠镜和腹腔镜处理急性胆源性胰腺炎均较为安全有效，综合考虑病人具体情况，合理选择手术方式将可达到理想的临床效果。

Objective To compare the clinical effectiveness of duodenoscope vs. laparoscope for acute biliary pancreatitis（ABP）. Methods Eighty-nine cases of ABP were randomly divided into duod- enoscope group（45 cases）and laparoscope group（44 cases）. The white blood cell count（WBC）, total bilirubin（TBIL）, alanine aminotransferase（ALT）, blood amylase（BAMS）, and interleukin-10（IL-10） and the infection rate of biliary tract were analyzed before and after operation. All operations of patients were performed within 72 h after attack. Results The WBC, and the levels of TBIL, ALT, BAMS, and IL-10 were reduced at the third day postoperation as compared with those before operation （P 〈0. 05）. The WBC was decreased dramatically, while the levels of BAMS were increased dramatically in laparoscope group as compared with duodenoscope group at the third days after operation（both P 〈0. 05）. The infection rate of biliary tract was 17. 8 % in duodenoscope group, which was higher significantly than in laparoscope group（2. 3 %）（P 〈0. 05）. Conclusion Both duodenoscope and laparoscope are safe and effective. The reasonable and selective application according to the conditions and information of patients can achieve ideal outcome for ABP.