内镜联合腹腔镜手术与开腹手术治疗重症急性胰腺炎并发胰腺假性囊肿的效果比较

A comparison of the clinical effects between endoscopic laparoscopic operation and open surgery on treating SAP with pancreatic pseudocyst

目的探讨内镜联合腹腔镜手术治疗重症急性胰腺炎并发胰腺假性囊肿的临床疗效及应用价值。方法选择该院治疗的重症急性胰腺炎并发胰腺假性囊肿患者88例,采用随机数字表法分为观察组和对照组各44例,对照组给予开腹手术治疗,观察组采取内镜联合腹腔镜手术治疗,观察并记录两组疗效。结果观察组腹痛缓解时间(2.34±0.34)d、体温恢复正常时间(3.54±0.87)d、肛门排气时间(4.79±0.88)d、灌洗引流时间(10.38±1.55)d、住院时间(20.08±3.45)d,均优于对照组的(4.88±1.03)d,(6.73±1.67)d,(9.97±1.81)d,(16.78±3.43)d,(34.18±7.64)d,组间比较差异有统计学意义(P<0.01)。观察组术后TNF-α(51.87±16.79)μg/L、IL-6(30.76±14.64)μg/L、IL-8(108.35±20.05)μg/L降低程度均优于对照组的(131.36±36.81)μg/L、(66.71±22.53)μg/L、(210.78±41.96)μg/L,组间比较差异有统计学意义(P<0.01)。结论内镜联合腹腔镜手术治疗重症急性胰腺炎并发胰腺假性囊肿能够缩短患者临床体征改善时间和住院时间,有效降低患者体内炎症因子浓度,值得临床推广使用。

Objective To investigate the application value of endoscopic combined with laparoscopic in the treatment of severe acute pancreatitis（ SAP） with pancreatic pseudocyst. Methods Eighty-eight patients with SAP and pancreatic pseudocyst in our hospital were randomly divide into the observation group and the control group. The control group was treated with open surgery and the observation group with endoscopy combined with laparoscopic operation. The clinical results were compared between the two groups. Results In the observation group,the time of abdominal pain relief was（ 2. 34 ± 0. 34） d,body temperature recovery（ 3. 54 ± 0. 87） d,anal exsufflation（ 4. 79 ±0. 88） d,lavage drainage（ 10. 38 ± 1. 55） d and hospital stay（ 20. 08 ± 3. 45） d. In the control group,the time of abdominal pain relief was（ 4. 88 ± 1. 03） d,body temperature recovery（ 6. 73 ± 1. 67） d,anal exsufflation（ 9. 97 ±1. 81） d,lavage drainage（ 16. 78 ± 3. 43） d and hospital stay（ 34. 18 ± 7. 64） d. The various time above in the observation group was significantly shorter than that in the control group（ P〈0. 01）. In the observation group,TNF-α was（ 51. 87 ± 16. 79） μg/L,IL-6（ 30. 76 ± 14. 64） μg/L,IL-8（ 108. 35 ± 20. 05） μg/L. In the control group,TNF-αwas（ 131. 36 ± 36. 81） μg / L,IL-6（ 66. 71 ± 22. 53） μg / L,IL-8（ 210. 78 ± 41. 96） μg / L. The improvements of the above biochemical indices in the observation group were significantly better than those in the control group（ P〈0. 01）. Conclusion Endoscope combined with laparoscope is effective in the treatment of severe acute pancreatitis complicated with Pancreatic pseudocyst.