内镜联合腹腔镜手术治疗重症急性胰腺炎合并胰腺假性囊肿的临床研究

Combined endoscopic and laparoscopic surgery in treatment for severe acute pancreatitis combined with pancreatic pseudo cyst

目的研究重症急性胰腺炎(SAP)合并胰腺假性囊肿患者采用内镜联合腹腔镜治疗的临床效果。方法临床纳入该院2013年6月-2016年6月收治的126例SAP合并胰腺假性囊肿患者作为研究对象,所有患者按入院顺序分为两组。其中,63例患者采用开腹手术进行治疗作为对照组,另63例患者采用内镜联合腹腔镜手术进行治疗作为研究组。观察两组患者手术情况、症状改善情况、炎症因子变化情况以及并发症情况。结果研究组患者手术时间和出血量为(109.14±30.48)min和(101.39±26.82)ml,均少于对照组患者的(146.85±31.23)min和(355.27±36.74)ml(P<0.05);研究组患者腹痛缓解时间、体温恢复时间、肛门排气时间以及住院时间分别为(2.54±0.39)h、(4.03±1.16)d、(8.28±1.94)d和(21.03±2.94)d,均短于对照组患者的(5.13±0.86)h、(7.47±1.62)d、(13.78±3.15)d和(31.79±3.42)d(P<0.05);治疗前两组患者白介素-6(IL-6)、白介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)水平比较差异均无统计学意义(P>0.05);治疗后研究组患者IL-6、IL-8和TNF-α水平分别为(31.12±9.86)μg/L、(109.54±21.23)μg/L和(51.92±14.76)μg/L,均低于对照组患者的(68.92±18.14)μg/L、(208.67±43.28)μg/L和(133.67±42.49)μg/L(P<0.05);研究组患者并发症发生率为7.94%,明显低于对照组患者的20.63%(P<0.05)。结论内镜联合腹腔镜手术对SAP合并胰腺假性囊肿的患者治疗效果较好,症状改善时间更短,有效抑制炎症因子的释放,降低炎症反应,且术后并发症较少,值得临床应用及推广。

【Objective】To study the clinical effect of combined endoscopic and laparoscopic surgery（CELS） in the treatment of severe acute pancreatitis（SAP） complicated with pancreatic pseudo cyst.【Methods】A total of 126 cases of SAP complicated with pancreatic pseudo cyst admitted in our hospital from June 2013 to June 2016 were enrolled. All patients were divided into two groups according to the order of admission, each group had 63 cases. Among them, 63 cases were treated by open surgery as control group and the other 63 patients were treated by CELS as the research group. The operation condition, the improvement of symptoms, the changes of inflammatory factors and complications in two groups of patients were observed.【Results】The operation time and blood loss in the research group were significantly less than those in the control group（P 0.05）. The time of abdominal pain relief, body temperature recovery time, anal exhaust time and hospitalization time in the research group were significantly shorter than those in the control group（P 0.05）. Before treatment, there were no differences in interleukin-6（IL-6）, interleukin-8（IL-8） and tumor necrosis factor alpha（TNF-α） levels between the two groups of patients（P 0.05）; after treatment, IL-6,IL-8 and TNF-α levels in the research group were significantly lower than those in the control group（P 0.05）. The incidence of complications in the research group and was 7.94%, which was significantly lower than 20.63% of the control group（P 0.05）.【Conclusion】For ASP patients with pancreatic pseudo cyst, CELS has better curative effect and shorter time of symptom improvement, it can effectively inhibit the release of inflammatory factors and reduce inflammation with less complication, so it is worthy of clinical application and promotion.