梗阻型急性胆源性胰腺炎两种疗法效果比较

Clinical observation of Mini-invasive therapy for obstructive acute biliary pancreatitis

目的比较腹腔镜和经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancr-eatography,ERCP)两种方法治疗梗阻型急性胆源性胰腺炎(acute biliary pancreatitis,ABP)的疗效。方法回顾性分析2010-03至2016-05收治的62例梗阻型ABP患者,所有患者均行磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)检查,明确诊断。其中腹腔镜治疗组39例,经ERCP联合十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)23例(ERCP组),比较术后两组患者检验指标,包括两组患者术前、术后的WBC、CRP、血清AMY指标,以及总住院时间、住院费用等指标。结果腹腔镜组及ERCP组术相关指标恢复速度:WBC[(4.35±0.87)d vs(5.15±1.04)d]、CRP[(3.35±1.23)d vs(3.64±0.87)d]、血清AMY[(4.37±0.89)d vs(4.86±0.79)d],两组比较差异无统计学意义(P>0.05);而总住院天数ERCP组[(12.5±1.5)d vs(8.5±2.0)d]较高(P<0.05);两组患者均治愈,无严重并发症及死亡病例。在随访中发现2例ERCP术后患者1个月内再次发生ABP。并发症发生率差异无统计学意义。结论腹腔镜是治疗梗阻型ABP的有效方法,并可以保留Oddi括约肌功能,安全可靠,患者受益率高。

Objective To evaluate the clinical effect of laparoscopic common bile duct exploration and ERCP in the treatment of obstructive acute biliary pancreatitis. Methods A retrospective analysis was made of the clinical data of 62 patients with obstructive acute biliary pancreatitis treated in our hospital between March 2010 and May 2014. All the patients had undergone conventional treat- ment beforemagnetic resonance cholangiopancreatography （MRCP） was used to confirm stones in the common bile duct. Among them, 39 patients received laparoscopic common bile duct exploration （laparoscopic group） , and the remaining 23 patients ERCP combined with EST （ERCP group）. The postoperative changes in white blood cell （WBC） count and C-reactive protein（CRP） , total hospitalization time and costs of surgery were compared between the two groups. Results There was no significant difference between the two groups （ P 〉 0. 05 ） in the time taken by blood test indicators to return to normal after operation ： WBC [ （ 4.35 ±0.87 ） d vs （ 5.15 ± 1.04 ） d ] ,CRP [ （ 3.35 ± 1.23 ） d vs （3.64 ± 0.87 ） d ] and blood AMY [ （4.37 ± 0.89 ） d vs （4.86 ± 0.79 ） d ] . The total hospitalization time was longer in ERCP group[ （ 12.5 ± 1.5） d vs （8.5 ± 2.0） d] （ P 〈 0.05 ）. In both groups, the cure rate was 100% and no severe complications or death occurred. During the follow-up, there were two patients whose acute biliary pancreatitis recurred in ERCP group. Conclusions Laparoseopie common bile duct exploration is safe, feasible and of more benefit for patients with obstructive acute biliary pancreatitis, and it can retain the function of the Oddig sphincter.