胆囊切除术不同手术时机对急性胆石性胰腺炎疗效的影响

Influence of different operation opportunity on clinical effects of laparoscopic cholecystectomy in the treatment of patients with acute gallstone pancreatitis

目的探讨手术时机对腹腔镜胆囊切除术治疗急性胆石性胰腺炎疗效的影响.方法回顾性分析93例急性胆石性胰腺炎患者临床资料,手术方式均为腹腔镜胆囊切除术,按手术时机分为研究组45例（早期：48 h内）与对照组48例（延期：8~12周后）,比较两组患者手术指标、生化指标、生活质量改善情况、复发及并发症发生情况.结果术中出血量及手术时间比较差异均无统计学意义（t=0.332、0.486,均P〉0.05）.研究组住院时间较对照组短[（11.43±2.65）d比（20.51±3.42）d],差异有统计学意义（t=14.245,P〈0.05）.术后7 d时两组生化指标均明显降低,与术后1 d时比较差异均有统计学意义（t=17.184、35.209、12.018、7.452、16.045、36.124、12.337、7.038,均P〈0.05）.术后1 d及术后7 d时两组生化指标差异均无统计学意义（t=0.431、0.663、0.664、1.118、0.085、0.156、0.283、0.262,均P〉0.05）.治疗后两组生活质量明显改善,与治疗前比较差异均有统计学意义（t=5.017、7.028、6.124、3.095、6.023、6.995、6.184、3.128,均P〈0.05）.两组患者复发及并发症发生情况（4.44%比2.08%、6.67%比10.42%）比较差异均无统计学意义（x2=0.412、0.081,均P〉0.05）.结论早期行腹腔镜胆囊切除术可缩短急性胆石性胰腺炎患者住院时间,疗效与安全性良好.

Objective To evaluate the influence different of operation opportunity on clinical effects of laparoscopic cholecystectomy in the treatment of patients with acute gallstone pancreatitis.Methods A retrospective analysis was made on 93 patients with acute gallstone pancreatitis,laparoscopic cholecystectomy was performed in all patients.And the patients were divided into research group（early：within 48 h）and control group（delay：over 8 to 12 weeks）by operation opportunity.The operation index,biochemical index,quality of life,recurrence and complication occurrence between the two group were compared.Results There were no significant differences in the amount of blood loss and operation time between the two groups（t=0.332,0.486,all P〉0.05）.The hospital stay of the research group was lower than that of the control group[（11.43±2.65）d vs.（20.51±3.42）d],the difference was statistically significant（t=14.245,P〈0.05）.7 d after operation,the biochemical indicators of the two groups were all decreased,and had significant differences compared with 1 d after operation（t=17.184,35.209,12.018,7.452,16.045,36.124,12.337,7.038,all P〈0.05）.But there was no significant difference in biochemical index between the two groups at 7 d and 1 d after operation（t=0.431,0.663,0.664,1.118,0.085,0.156,0.283,0.262,all P〉0.05）.The life quality of the two groups were greatly improved after treatment,and had significant difference compared with before treatment（t=5.017,7.028,6.124,3.095,6.023,6.995,6.184,3.128,all P〈0.05）.There were no significant differences in the incidence rates of recurrence and complications（4.44% vs 2.08%,6.67% vs.10.42%）between the two groups（x2=0.412,0.081,all P〉0.05）.Conclusion Early laparoscopic cholecystectomy can shorten the length of stay in patients with acute gallstone pancreatitis ,and with good clinical effects and safety.