腹腔镜联合胆道镜在重症急性胰腺炎继发胰腺脓肿中的应用

Laparoscopy combined with cholangioscopy for the treatment of pancreatic abscess after severe acute pancreatitis

目的:探讨腹腔镜、胆道镜联合应用在重症急性胰腺炎继发胰腺脓肿中的临床应用价值.方法:回顾性分析我院2000-06/2011-06随机使用腹腔镜、胆道镜联合及开腹手术治疗重症急性胰腺炎继发胰腺脓肿的38例患者,包括一般资料、手术时间、术中出血量、术后肠道功能恢复时间、术后白细胞、肝功能变化、术后并发症、死亡率、住院时间、住院费用等.结果:腹腔镜、胆道镜联合治疗组和开腹组在患者组成、手术时间、住院时间、死亡率等方面无统计学差异,治疗组在术中失血量(108.2 mL±18.1 mLvs 137.4 mL±25.2 mL)、术后肠道恢复时间(26.8 h±9.7 h vs 31 h±10.1 h)、术后肝功能变化(碱性磷酸酶:76.7U/L±12.6 U/L vs 83.2 U/L±13.6 U/L;谷氨酰转肽酶计数:60.3 U/L±14.1 U/L vs 67.1 U/L±13.8 U/L)、术后并发症(19.0%vs 41.2%)、住院费用(49.3千元±0.9千元vs 43.2千元±0.6千元)上与对照组差异显著(P<0.05).结论:腹腔镜、胆道镜联合治疗重症急性胰腺炎继发胰腺脓肿安全可靠、更加合理,有一定临床意义,但其费用较高,手术时间及住院时间稍长,需加以改进.

AIM： To evaluate the value of laparoscopy combined with cholangioscopy in the treatment of pancreatic abscess after severe acute pancreatitis.METHODS： The clinical data for 38 patients with pancreatic abscess after severe acute pancreatitis who underwent laparoscopy and cholangioscopy co-therapy or open surgery in Nankai Hospital from June 2000 to June 2011 were retrospectively analyzed,including general information,operative time,intraoperative blood loss,postoperative intestinal recovery time,WBC and liver function changes,postoperative complications,mortality,hospital stay,and hospitalization costs.RESULTS： The laparoscopy and cholangioscopy co-therapy group had no significant differences with the open group in general information,patient composition,operative time,hospital stay,and mortality.However,significant differences were noted in intraoperative blood loss（108 mL ± 18 mL vs 137 mL ± 25 mL）,postoperative intestinal recovery time（26.8 h ± 9.7 h vs 31 h ± 10.1 h）,liver function changes at 2 weeks postoperatively（ALP： 76.7 U/L ± 12.6 U/L vs 83.2 U/L ± 13.6 U/L;GGT： 60.3 U/L±14.1 U/L vs 67.1 U/L±13.8 U/L）,incidence of postoperative complications（19.0% vs 41.2%）,hospitalization costs（49.3 ± 0.9 thousand Yuan vs 43.2 ± 0.6 thousand Yuan） between the two groups（all P 〈 0.05）.CONCLUSION： Laparoscopy and cholangioscopy co-therapy is a safe,effective,and minimally invasive treatment for pancreatic abscess after severe acute pancreatitis but is associated with higher cost and longer operation time and hospital stay.