胆囊结石并发胆源性重症急性胰腺炎行腹腔镜胆囊切除术手术时机的探讨

Laparoscopic cholecystectomy in cholecystolithiasis patients with acute biliary servere pancreatitis

目的 探讨胆囊结石合并胆源性重症急性胰腺炎（acute biliary servere pancreatitis,ABSP）应用腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）治疗的可行性及手术时机.方法 回顾性分析我院2008年7月至2011年6月16例胆囊结石合并胆源性重症急性胰腺炎患者应用LC治疗的临床资料.结果 16例患者在保守治疗12～27d后均成功行LC术,无中转开腹,手术时间30～145min,平均63min.术中出血量20～330ml,平均80ml.6例放置腹腔引流管,均于术后24～72h拔除腹腔引流管,无胆漏及出血.住院15～31d,平均19d.16例术后随访4～36个月均无复发病例.结论 对于胆囊结石合并胆源性重症急性胰腺炎患者,在临床症状和体征基本消失,可进低脂饮食后,可安全实施LC术.

Objective To explore the feasibility and the selection of laparoscopic cholecystectomy （LC） for cholecystolithiasis with acute biliary servere pancreatitis （ABSP）. Methods Sixteen patients who underwent LC between July 2008 and June 2011 because of cholecystolithiasis with ABSP in our hospital were retrospectively studied. Results All of the patients had LC successfully after 12 - 27 days of conservative treatment without conversion to open operation. The operation time was 30 - 145 min （mean, 63 min）, and the intraoperative blood loss was 20 - 330 ml（ mean, 80 ml）. No postoperative biliary hemorrhage or leakage occurred. The hospital stay was 15 -31 days（ mean, 19 days）. Follow-up in 16 patients for 4 - 36 months found no recurrence of pancreatitis or cholelithiasis. Conclusion LC could be performed safely in patients of cholecystolithiasis with ABSP when clinical symptoms and signs are relieved and the patients have low fat diet.