腹腔镜手术与十二指肠镜手术早期治疗胆源性重症急性胰腺炎疗效分析

Clinical effects of laparoscopic therapy and duodenoscopic therapy in the treatment of biliary severe acute pancreatitis

目的探讨腹腔镜手术与十二指肠镜手术早期治疗胆源性重症急性胰腺炎临床疗效。方法 140例胆源性重症急性胰腺炎患者按治疗方案分为两组:腹腔镜治疗组(60例),十二指肠镜治疗组(80例),比较两组急性生理功能和慢性健康状况评分(APACHEⅡ评分)、白细胞(WBC)、C反应蛋白(CRP)、手术时间、术中出血量、住院时间、住院费、并发症发生率、治愈率、病死率、腹痛消失时间、体温恢复正常时间、血淀粉酶恢复正常时间、丙氨基酰氨基转移酶(ALT)恢复正常时间、总胆红素(TBIL)恢复正常时间、碱性磷酸酶(ALP)恢复正常时间。结果两组术后APACHEⅡ评分、WBC、TBIL、ALT及CRP水平均较术前显著性下降(P<0.05),两组在同时间点比较差异无统计学意义(P>0.05)。十二指肠镜治疗组的手术时间和术中出血量显著少于腹腔镜治疗组(P<0.05);两组住院时间、住院费、并发症发生率、治愈率、病死率、腹痛消失时间、体温恢复正常时间、血淀粉酶恢复正常时间、ALT恢复正常时间、TBIL恢复正常时间、ALP恢复正常时间差异均无统计学意义(P>0.05)。结论早期采用腹腔镜手术或与十二指肠镜手术均能有效治疗胆源性重症急性胰腺炎,且疗效相近。

Objective To discuss the clinical effects of laparoscopic therapy and duodenoscopic therapy in the treatment of biliary severe acute pancreatitis.Methods A total of 140 patients with biliary severe acute pancreatitis（BSAP）in our hospital was assigned into laparoscopic therapy group（60 cases）and duodenoscopic therapy group（80 cases）according to the treatment plan,and indicators in both groups were compared,including acute physiology and chronic health evaluation（APACHEⅡscore）,WBC,CRP,the operation time,intraoperative blood loss,hospitalization time,hospitalization fee,complication rate,cure rate,mortality rate,abdominal pain disappearing time,body temperature recovered to normal time,blood amylase recovered to normal time,amino acid transaminase（ALT）recovered to normal time,total bilirubin（TBIL）recovered to normal time,alkaline phosphatase（ALP）recovered to normal time.Results APACHEⅡscores and the levels of WBC,TBIL,ALT and CRP in both groups were significantly decreased after surgery（P〈0.05）,but there were no statistical differences between the two groups at the same time point after treatment（P〉0.05）.The operative time and the intraoperative blood loss in the duodenoscopic therapy group were significantly less than those in laparoscopic therapy group（P〈0.05）.There were no statistical differences between the two groups of hospitalization time,complication rate,cure rate,mortality rate,abdominal pain disappearing time,temperature returned to normal time,blood amylase recovered to normal time,ALT recovered to normal time,TBIL recovered to normal time,ALP recovered to normal time（P〈0.05）.Conclusion In early stage,both laparoscopic therapy and duodenoscopic therapy can treat BSAP effectively,and their therapeutic effects are nearly similar.