轻型急性胆石性胰腺炎的手术时机和方法

Timing and Mode of Surgical Treatment for Mild Acute Gallstone Pancreatitis.

目的：探讨轻型急性胆石性胰腺炎（ＡＧＰ）的手术时机和方法。方法：回顾性分析１２６例急性胆石性胰腺炎患者的临床资料和治疗结果。结果：早期手术组（入院４８ｈ之内，ｎ＝４３）并发症发生率较延期（入院４８ｈ之后，同一次住院时间内）开腹手术组（ｎ＝２２）、延期腹腔镜手术组（ｎ＝２０）和非手术治疗组（ｎ＝４１）显著升高（Ｐ＜０.０５），平均住院时间显著延长（Ｐ＜０．０５）。早期手术组和延期开腹手术组胆总管探查率分别为１００％和３０．８％（Ｐ＜０．０５）。胆石性胰腺炎非手术治疗出院后复发率高（３４.１％）。平均住院时间，延期ＬＣ组为１４．８ｄ±０．７ｄ，较延期开腹手术组２６.７ｄ±３．０ｄ显著缩短（Ｐ＜０.０５）。延期ＬＣ组手术时间为入院后１０．５ｄ±０．６ｄ。结论：轻型ＡＧＰ患者早期行非手术治疗，在症状、体征消失后一周左右（发病后１１ｄ）经ＭＲＣＰ和Ｂ超检查后行ＬＣ，如ＭＲＣＰ发现胆总管结石则在ＬＣ术前行ＥＲＣＰ＋ＥＳ。

To explore the best timing and mode of surgical treatment for acute gallstone pancreatitis(AGP). Methods: The clinical records and therapeutic results of 126 patients with mild AGP were reviewed and ana- lysed retrospectively. Results: The incidence of complication of patients who were operated upon ＜48 hours after admission(n=43) was significantly higher than those who were subjected respectively to conservative the- rapy(n=41), delayed cholecystectomy and/or exploration of the common bile duct ＞48 hours after admission(n = 22) and delayed laparoscopic cholecystectomy(LC, n = 20)(P<0.05); the rate of common bile duct exploration was significantly higher in the early operated group than that of delayed operated group. Patients subjected to early open surgery had the longest duration of hospitalization(Ｐ＜0.05). Patients subjected to conservative therapy ex- perienced a recurrent rate of 34.1%. Delayed LCs were carried out 10.5d±0.6d after admission. Conclusions: In early stage of mild AGP, MRCP and B-US should be repeated after the signs and symptoms have subsided (usu- ally 11 days after attack), then LC and/or ERCP+ES is contemplated