内镜与腹腔镜联合治疗SAP并发胰腺假性囊肿患者效果观察及对应激反应的影响

Effect of endoscopic combined with laparoscopic treatment on SAP complicated with pancreatic pseudo cyst and stress response

目的探讨内镜与腹腔镜联合治疗重症急性胰腺炎(SAP)并发胰腺假性囊肿患者效果及对患者应激反应的影响。方法选择60例SAP并发胰腺假性囊肿患者,随机分为观察组30例与对照组30例。对照组采用传统开腹手术治疗,观察组采用内镜与腹腔镜联合治疗。比较两组患者术中出血量、灌洗引流时间、住院时间、腹痛缓解时间、排气时间及术前和术后48 h应激反应指标水平变化。结果观察组术中出血量少于对照组,灌洗引流时间短于对照组,住院时间短于对照组,且差异均有统计学意义(t分别=10.91、8.89、7.91,P均<0.05);观察组腹痛缓解时间和排气时间均快于对照组,且差异均有统计学意义(t分别=10.52、8.66,P均<0.05);两组术后48 h血清皮质醇和去甲肾上腺素水平均增加,且差异均有统计学意义(t分别=3.30、2.27;16.99、21.44,P均<0.05);观察组术后48 h血清皮质醇和去甲肾上腺素水平低于对照组,且差异均有统计学意义(t分别=14.12、18.49,P均<0.05)。结论内镜与腹腔镜联合治疗SAP并发胰腺假性囊肿患者效果明显,对患者应激反应影响小。

Objective To explore the effect of endoscopic combined with laparoscopic treatment on SAP complicated with pancreatic pseudo cyst and stress response. Methods A total of 60 cases of SAP complicated with pancreatic pseudo cyst were selected and randomly divided into observation group and control group with 30 cases in each. The control group was treated with conventional open surgery,and the observation group was treated by endoscopic combined with laparoscopic surgery. The bleeding volume,lavage and drainage time,hospital stay,abdominal pain relief time, exhaust time and the 48 hours stress response indicators level changes before and after operation of two groups were compared. Results The bleeding volume of observation group was less than that of the control group,and lavage and drainage time and hospitalization time were shorter than those of the control group （t=10.91,8.89,7.91,P〈0.05）. The abdominal pain and exhaust time of observation group were faster than that of the control group（t=10.52,8.66,P〈0.05）. After 48 hours,the serum cor and NE levels in the two groups were significantly increased （t=3.30,2.27;16.99,21.44, P〈0.05）. The serum cor and NE levels after 48 hours in the observation group were significantly lower than the control group （t=14.12,18.49,P〈0.05）. Conclusion The effect of endoscopic combined with laparoscopic treatment on SAP complicated with pancreatic pseudo cyst is obvious. The stress response is slight.