急性胆源性胰腺炎胆道疾病的外科处理

Surgical treatment of biliary duct diseases in acute biliary pancreatitis

目的:探讨急性胆源性胰腺炎(ABP)患者胆道疾病手术治疗的方法及时机。方法:回顾性分析206例ABP行胆道疾病处理的患者临床资料,其中轻型192例,中重型2例,重型12例;手术方式包括胆囊切除术、胆总管切开取石T管引流术、ERCP、肝叶部分切除术等。结果:中重型及重型ABP患者均在非手术治疗后早期行外科处理;轻型ABP患者中与早期手术者(起病2周内)抗生素使用时间、总住院时间、住院费用较延期手术者(起病2周后)明显减少,同期手术者抗生素使用时间、总住院时间、总费用较择期手术者明显减少(P<0.05)。结论:ABP患者胆道手术方式需根据患者情况选择,轻型患者应在同次住院期间且起病早期行胆道手术治疗;重型患者应在非手术治疗整体情况缓解后尽早行手术治疗;如有胆道梗阻或胆管炎无论轻重均应急诊手术或ERCP。

Objective： To investigate the method and timing of surgical treatment of biliary duct diseases in patients with acute biliary pancreatitis （ABP）. Methods： The clinical data of 206 ABP patients undergoing surgical treatment for bile duct diseases were retrospectively analyzed. Of the patients, 192 cases had mild disease, 2 cases had moderately severe disease, and 12 cases had severe disease. The surgical procedures included cholecystectomy, choledocholithotomy-T-tube drainage, ERCP and partial hepalobectomy. Results： All patients with moderately severe or severe ABP underwent early surgical treatment after non-surgical treatment. In patients with mild ABP, the time of antibiotic administration, overall length of hospital stay and hospitalization cost were significantly reduced in cases undergoing early surgical treatment （within two weeks of onset） compared with those undergoing delayed surgical treatment （after two weeks of onset）, and the time of antibiotic administration, overall length of hospital stay and total cost in cases undergoing surgical treatment during admission were significantly reduced compared with those undergoing elective surgery （all P〈0.05）. Conclusion： Biliary tract surgery in ABP patients should be tailored according to patient＇s specific condition, which should be performed during the time of same admission and early after onset for mild cases, and in severe cases, it should be performed as soon as possible after the relief of the overall conditions by non-surgical treatment. Emergency surgery or ERCP should be performed for those with biliary obstruction or cholangitis regardless of mild or severe presentation.