早期微创治疗胆源性急性胰腺炎

Early minimally invasive treatment for biliary acute pancreatitis

目的评价两种治疗胆源性急性胰腺炎的微创方法是否存在疗效差异。方法前瞻性收集63例在发病72h内接受微创治疗的BAP患者，患者被分成两组：早期腹腔镜胆囊切除＋胆道镜经胆囊管胆管探查组和经内镜鼻胆管引流组。观察两组术后第1、3、5天血、尿淀粉酶，氨基转移酶，局部并发症发生率以及6个月以内复发率。结果两组术后第1天血淀粉酶差异有统计学意义（P：0．04），两组术后第3、5天淀粉酶、氨基酸转移酶差异均无统计学意义（均P〉0．05）；胰腺假性囊肿发生率分别为5．4％、7．7％，差异无统计学意义（P=0．42）；6个月以内复发率分别为：2．7％、19．2％，差异有统计学意义（P=0．006）。结论早期腹腔镜胆囊切除＋胆道镜经胆囊管胆管探查与经内镜鼻胆管引流术治疗胆源性急性胰腺炎住院期间疗效无明显差异，但经内镜鼻胆管引流术6个月以内急性胰腺炎复发率偏高，早期行腹腔镜胆囊切除＋胆道镜经胆囊管胆管探查可能是治疗早期胆源性急性胰腺炎更为有效的微创术式。

Objective To investigate the clinical effects of two minimally invasive surgical treatments for billary acute pancretitis. Method In this study, 63 patients with billary acute pancretitis were prospectively divided into two groups. Patients in group A received laparoscopic cholecystectomy （LC） and laparoscopic transcyctic common bile duct exploration （LTCBDE） within 72 hours of onset, group B underwent endoscopic nasobiliary drainage （ENBD）. The two groups were evaluated by blood amylase and urine amylase, alanine aminotransferase, aspartate aminotransferase on postoperative day 1, 3, 5, local complication and the recurrence rate within 6 months. Result Blood amylase was lower in group A than that in group B （P = 0.04） on postoperative day 1. There were no significant differences in amylase, aminotransferase of two groups on postoperative day 3, 5 （ all P 〉 0. 05 ）. The incidences of local complications and pancreatic necrosis infection were 2.7% , 7.7% respectively（ P = 0.13 ） ; the incidences of pancreatic pseudocyst were 5.4%, 7. 7% （P =0.42） ; the recurrence rate within 6 months were 2. 7% and 19. 2% respectively （P = 0. 006）. Conclusions The clinical curative effects of early LC and LTCBDE or ENBD on billary acute pancretitis showed no significant differences, but the recurrence rate of acute pancretitis within 6 months revealed that early LC and LTCBDE may be more effective.