内镜腹腔镜联合治疗重症急性胰腺炎并发胰腺假性囊肿的疗效分析

Clinical analysis of endoscopic combined laparoscopic surgery in treating severe acute pancreatitis 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(SAP)伴胰腺假性囊肿(PPC)的效果。方法选取2014年8月至2016年7月收治的SAP伴PPC患者110例,将患者随机分为内镜组57例和开腹组53例,内镜组给予内镜联合腹腔镜手术治疗,开腹组给予开腹手术治疗,统计分析采用SPSS 19.0统计软件,计量资料采用(x±s)表示,两组手术情况、术后指标及炎症因子比较使用t检验;两组治疗有效率及术后并发症发生率比较使用χ~2检验,以P<0.05表示差异具有统计学意义。结果内镜组和开腹组治疗有效率分别为92.9%和90.6%,差异比较无统计学意义(P>0.05);内镜组手术时间和术中出血量分别为(110.0±41.2)min和(100.5±30.1)ml,明显少于开腹组(P<0.05);内镜组肛门排气时间、灌洗引流时间和住院时间分别为(5.0±0.8)d、(10.5±1.7)d和(21.2±4.5)d,均明显短于开腹组(P<0.05);内镜组治疗后IL-6、IL-8和TNF-α分别为(32.3±13.8)g/L、(110.0±24.1)g/L和(55.1±16.2)g/L,明显低于开腹组(P<0.05);内镜组和开腹组术后并发症发生率分别为5.3%和7.6%,差异比较无统计学意义(P>0.05)。结论内镜联合腹腔镜手术治疗SAP伴PPC,具有较好的治疗效果,能明显降低患者IL-6、IL-8等炎症因子水平。

Objective To investigate clinical outcome of endoscopic combined with laparoscopic surgery in treatomg severe acute pancreatitis （SAP） with pancreatic pseudo cyst （PPC）. Methods From August 2014 to July 2016, 110 patients with SAP and PPC were randomly divided into endoscopic group （n=57） and laparotomy group （n=53）. Patients in endoscopic group received endoscopic combined with laparoscopic surgery, while patients in iaparotomy group underwent open surgery. Statistical analysis were performed by using SPSS 19.0 software. Measurement data such as perioperative indicators and inflammatory indexes were expressed as mean ± standard deviation （x ± s ） , and were examined by using t test. Count data, such as postoperative complication rate were expressed as 0/0 , and were examined by usingx2 test. A P value 〈 0. 05 was considered as statistically significant difference. Results Effective rate in the endoscopic group was 92.9% and 90.6% in laparotomy group, without significant difference （ P 〉 0.05 ）. The operation time and blood loss in the endoscopic group were （110.0 ± 41.2） rain and （100.5±30.1 ） ml, which were significantly less than those in the laparotomy group （ P 〈 0.05 ）. In endoscopic group, anal exhaust time, lavage drainage time and hospital stay were （5.0 ± 0.8） d, （ 10.5±1.7） d and （21.2±4.5） d, which were significantly shorter than those in laparotomy group respectively （P 〈0.05）. In endoscopic group, Postoperative IL-6, IL-8 and TNF-α were （32.3±13.8） g/L, （110.0 ±24.1 ） g/L and （55. 1±16. 2 ） g/L, which were significantly lower than those in laparotomy group respectively （P 〈 0.05 ）. There no significant difference of postoperative complications of 5.3% in endoscopic group and 7.6% in laparotomy group （P 〉 0.05 ）. Conclusion Endoscopic combined with laparoscopic surgery in treating SAP with PPC could achieve a good therapeutic effect, could also reduce the levels of inflammatory factors such as IL-6, IL-8.