胆囊结石并发急性胰腺炎患者的微创治疗96例分析

Clinical analysis of mini-invasive surgery in management of patients with biliary pancreatitis: Report of 96 cases

目的探讨胆囊结石并发急性胰腺炎患者行腹腔镜胆囊切除术的手术时机。方法选取2009年7月至2014年6月收治的96例轻中度急性胆石性胰腺炎施行早期和延期腹腔镜胆囊切除术患者。按手术时机的不同,分为早期组(50例)和延期组(46例)。采用SPSS 20.0进行分析处理,住院时间、手术时间、术中出血量、术后生化指标、入院及出院时生活质量核心量表(QLQ-C30)均采用均数±标准差表示,并行t检验,术后急性胰腺炎复发率、术后并发症发生率采用χ2检验,P<0.05为差异有统计学意义。结果早期组住院时间(11.5±2.2)d明显低于延期组(21.2±3.5)d(t=12.951,P<0.01)。两组手术时间、术中出血量、术后急性胰腺炎复发率、术后并发症发生率、术后第1天、第7天谷丙转氨酶+谷草转氨酶及碱性磷酸酶、治疗前和治疗后两组生理功能、精神健康、社会功能和情感智能评分比较,差异均无统计学意义(P>0.05)。结论对于诊断明确的轻中度急性胆石性胰腺炎患者,早期行腹腔镜胆囊切除术可有效缩短住院时间,安全可靠。

Objective To investigate the timing of laparoscopic cholecystectomy for patients with biliary pancreatitis. Methods From July 2009 to June 2014, 96 patients with mild-to-moderate biliary pancreatitis underwent laparoscopic cholecystectomy in our hospital, who were divided into early operation group （50 patients） and delayed operation group （46）. Clinical data including hospital stay, operation time, blood loss, postoperative biochemical indicators, admission and discharge, and the core quality of life scale （QLQ-C30） were analyzed using the SPSS 20.0 software. The data were finally expressed as mean ＋ SD and examined by Student＇ s t test. The recurrence rate of postoperative acute pancreatitis, and the incidence of postoperative complications were examined by the Chi-square test. A P value 〈 0.05 was considered statistically significant. Results The hospital stay of the early operation group was （ 11.5 ±2.2 ） d, which was significantly lower than that of the delayed operation group （21.2 ±3.5 ） d （ t = 12. 951, P 〈 0.01 ）. There was no significant difference between 2 groups in operation time, blood loss, recurrence rate of postoperative acute pancreatitis, complication rate, postoperative day 1, day 7 ALT ＋ AST, alkaline phosphatase, pre- and post-operative physiological function, mental health, social activities and emotional intelligence （P 〉 0. 05 ）. Conclusion For patients with biliary pancreatitis, early laparoscopic cholecystcctomy is safe and reliable, and could reduce the duration of hospitalization.