腹腔镜联合钬激光碎石治疗慢性胰腺炎合并胰管结石

Laparoscopy combined with holmium laser in the treatment of chronic pancreatitis complicated with pancreatic ductal stones

目的探讨腹腔镜联合输尿管软镜钬激光治疗慢性胰腺炎合并胰管结石的安全性和有效性。方法将2012年1月至2018年8月浙江省人民医院外科收治的58例慢性胰腺炎合并胰管结石患者中行腹腔镜胰管纵形切开取石+胰管空肠Roux-en-Y吻合术的31例患者随机分为两组,腹腔镜联合输尿管软镜钬激光碎石治疗组(10例,A组)和腹腔镜治疗组(21例,B组),对其手术时间、术中出血量、术中中转开腹率、胰管切开长度、术后胰瘘发生率、术后住院时间、结石残留率、术后腹痛缓解率进行统计分析。结果31例患者中转手术3例(3/31),均临床治愈出院,无围手术期死亡。A、B组的胰管切开长度(5.0±0.8比6.5±1.0)cm、手术时间(289.3±51.6比349.5±34.7)min、术后住院时间(8.0±1.2比10.2±1.6)d,差异均有统计学意义(均P<0.05)。A、B组中转开腹率、术中出血量、术后胰瘘发生率、结石残留率、术后腹痛缓解率比较差异无统计学意义(P>0.05)。结论腹腔镜治疗慢性胰腺炎合并胰管结石安全可行。联合输尿管软镜钬激光碎石,具有胰肠吻合口内径适中、手术时间短、术后住院时间短等优势。

Objective To study the safety and feasibility of laparoscopy combined with holmium laser in the treatment of chronic pancreatitis complicated with pancreatic ductal stones. Methods To compare the clinical data in patients who underwent laparoscopy combined with holmium laser (10 patients, group A) with those who underwent laparoscopy only (21 patients, group B) at Zhejiang Provincial People’s Hospital from January 2012 to August 2018. The operation time, intraoperative blood loss, intraoperative conversion rate, pancreatic ductal incision length, postoperative pancreatic fistula rate, length of postoperative hospital stay, residual stone rate and relief of postoperative abdominal pain rate of the two groups were documented and analyzed. Results Three of 31 patients were converted to open surgery. The remaining patients in the two groups were discharged home without any perioperative death. Group A and B were significant differences in the pancreatic ductal incision length (5.0±0.8 vs. 6.5±1.0) cm, operation time (289.3±51.6 vs. 349.5±34.7) min, and postoperative hospital stay (8.0±1.2 vs. 10.2±1.6) d between the two groups (P<0.05). There were no significant differences in the intraoperative conversion to open rate, intraoperative blood loss, postoperative pancreatic fistula rate, residual stone rate and relief of postoperative abdominal pain rate between the two groups (P>0.05). Conclusions It was safe and feasible to treat chronic pancreatitis complicated with pancreatolithiasis by laparoscopy. Laparoscopy combined with holmium laser had the added advantages of easy access through the pancreaticojejunostomy, shorter operation time, and less intraoperative blood loss.