不同时期腹腔镜胆囊切除术治疗急性胰腺炎合并胆囊结石的效果分析

Effect analysis of laparoscopic cholecystectomy in different periods in the treatment of acute pancreatitis complicated with gallstone

目的 探讨不同时期腹腔镜胆囊切除术治疗急性胰腺炎合并胆囊结石的效果。方法 选取本院2013年4月-2014年4月的100例行腹腔镜胆囊切除术（LC）治疗的急性胰腺炎合并胆囊结石患者作为研究对象,按照手术操作时间分为早期腹腔镜手术组（n=41）与延期腹腔镜手术组（n=59）。早期腹腔镜手术组行早期LC术治疗,延期腹腔镜手术组先行保守治疗后再择期行LC术治疗,比较两组的住院时间、胰腺炎复发率及患者各项综合指标。结果 早期腹腔镜手术组的住院时间显著短于延期腹腔镜手术组,差异有统计学意义（P〈0.05）。两组的胰腺炎复发率比较,差异无统计学意义（P〉0.05）。两组术后1 d的丙氨酸氨基转移酶水平显著低于术前,术后3 d的天门冬氨酸氨基转移酶水平显著低于术前,术后5 d的平均碱性磷酸酶显著低于术前,差异有统计学意义（P〈0.05）。早期腹腔镜手术组术后7 d的丙氨酸氨基转移酶水平显著低于延期腹腔镜手术组术后7 d,差异有统计学意义（P〈0.05）。两组术后7 d的天门冬氨酸氨基转移酶和平均碱性磷酸酶水平比较,差异无统计学意义（P〉0.05）。结论对于急性胰腺炎合并胆囊结石的治疗,早期腹腔镜胆囊切除术与延期手术在治疗效果和复发情况等方面无明显区别,但早期手术可显著降低患者的平均住院时间,值得临床推广应用。

Objective To explore the effect of laparoscopic cholecystectomy（LC） in different periods in the treatment of acute pancreatitis complicated with gallstone.Methods 100 cases of acute pancreatitis complicated with gallstone treated by LC from April 2013 to April 2014 in our hospital were selected and divided into the early laparoscopic surgery group（n=41） and the delayed laparoscopic surgery group（n=59） according to the operation time.The early laparoscopic surgery group was given early LC treatment,the delayed laparoscopic surgery group was given scheduled for LC treatment after conservative treatment.Hospital stay,the recurrence rate of pancreatitis and the comprehensive index of the patients in the two groups was compared.Results The length of hospital stay in the early laparoscopic surgery group was shorter than that in the delayed laparoscopic surgery group,with significant difference（P〈0.05）.There was no significant difference in the recurrence rate of pancreatitis between the two groups（P〈0.05）.The level of alanine aminotransferase after operation at the first day in the two groups was lower than that before operation,the level of aspartate aminotransferase after operation at the third days in the two groups was lower than that before operation,the level of average alkaline phosphatase after operation at the fifth days in the two groups was lower than that before operation,with significant difference（P〈0.05）.The level of alanine aminotransferase after operation at the seventh days in the early laparoscopic surgery group was lower than that in the delayed laparoscopic surgery group,with significant difference（P〈0.05）.There was no significant difference in the level of aspartate aminotransferase and alkaline phosphatase after operation at the seventh days between the two groups（P〈0.05）.Conclusion For the treatment of acute pancreatitis associated with gallstone,the early LC and delayed surgery have no obvious difference in the treatment effect and recurrence,but the eauy LC can significantly reduce the average length of stay,it is worthy of clinical promotion and application.