两种微创手术方式治疗急性胆源性胰腺炎伴胆道梗阻的疗效比较

Comparison of two modalities of minimally invasive surgery in treatment of acute biliary pancreatitis

目的 比较腹腔镜胆总管探查术＋胆囊切除术（LCBDE＋ LC）与经内镜逆行胰胆管造影术＋经内镜乳头括约肌切开术＋腹腔镜胆囊切除术（ERCP＋ EST＋ LC）治疗急性胆源性胰腺炎合并胆道梗阻的临床疗效.方法 回顾性分析2012年1月至2016年1月于我院行外科手术的急性胆源性胰腺炎合并胆道梗阻106例患者的临床资料.其中,行LCBDE＋ LC者54例（LCBDE组）,行ERCP＋ EST＋ LC者52例（ERCP组）.比较两组患者的手术时间、术中出血量、住院情况及术后并发症发生率.结果 LCBDE组平均手术时间长于ERCP组[（110.2±11.2） min比（100.8±22.8）min,t=-2.11,P＜0.05];住院时间[（10.3±3.8）d比（12.6±3.4）d,t=2.32,P＜0.05]、住院费用[（31 245.3±1 237.2）元比（42 342.2±1 354.3）元,t=2.82,P＜0.01]少于ERCP组;两组患者术中出血量[（40.2±10.3） ml比（39.3±10.4） ml,t=0.88]、术后使用镇痛比例[11.11％ （6/54）比13.46％（7/52）,χ^2=0.102]、术后并发症发生率[9.26％（5/54）比11.54％（6/52）,χ^2=0.080]比较,差异无统计学意义（均P＞0.05）.结论 LCBDE＋ LC微创手术方式治疗急性胆源性胰腺炎合并胆道感染患者住院时间短,费用少,具有临床可行性.

Objective To compare the therapeutic efficacy of laparoscopic common bile duct exploration （LCBDE） plus laparoscopic cholecystectomy （LC）,and endoscopic retrograde cholangiopancretography （ERCP） plus endoscopic sphinetemtomy （EST） plus laparoscopic cholecystectomy （LC） in treatment of acute biliary pancreatitis.Method One hundred and six patients with acute biliary pancreatitis and biliary obstruction underwent minimally invasive surgery between January 2012 and February 2016 in our hospital,including 54 cases received LCBDE ＋ LC （LCBDE group） and 52 cases received ERCP ＋ EST ＋ LC （ERCP group）.The operation time,intraoperative blood loss,length of hospital stay,medical expenses and postoperative complications were compared between two groups.Results The operating time in LCBDE group was longer than that in ERCP group [（110.2 ± 11.2） min vs.（100.8 ±22.8） min,χ^2 =-2.11,P 〈 0.05],the length of hospital stay was shorter [（10.3 ± 3.8） d vs.（12.6 ±3.4） d,χ^2 =2.32,P 〈 0.05],the medical expense was less [（31 245.3 ± 1 237.2） Yuan vs.（42 342.2 ±1 354.3）Yuan,χ^2 =2.82,P 〈 0.01].There were no significant differences in intraoperative blood loss [（40.2 ± 10.3） ml vs.（39.3 ± 10.4） ml,x2 =0.88,P 〉 0.05],the rate of postoperative analgesic use [11.11% （6/54） vs.13.46% （7/52）,χ^2 =0.102,P 〉0.05] and the incidence of postoperativecomplications [9.26% （5/54） vs.11.54% （6/52）,χ^2 =0.080,P 〉0.05] between two groups.Conclusion laparoscopic common bile duct exploration plus laparoscopic cholecystectomy has advantages of shorter hospital stay and lower medical expenses in treatment of acute biliary pancreatitis combined with biliary infection.