腹腔镜术中十二指肠镜留置鼻胆管引流早期治疗急性胆源性胰腺炎的疗效分析

Effect analysis of early treatment of acute biliary pancreatitis with duodenal endoscopic drainage during laparoscopy

目的探讨腹腔镜术中联合十二指肠镜留置鼻胆管引流早期治疗急性胆源性胰腺炎的疗效及可行性。方法回顾性分析2015年6月至2018年8月成都市第二人民医院入院诊断为急性胆源性胰腺炎、胆总管结石合并胆囊结石62例患者的临床资料,根据手术是否在48 h内进行分为早期组(48 h内手术)和晚期组(48 h后手术),每组各31例。比较2组患者手术时间,术后肠道功能恢复时间、鼻胆管拔除时间、腹腔引流管拔除时间,并发症发生情况,总住院时间,住院总费用,术后白细胞、血淀粉酶及总胆红素。结果 2组术后无胰腺炎复发。早期组与晚期组在肠道功能恢复时间[1(1,1) d vs 1(1,1) d]、术后第1天血淀粉酶[241(189,326) U/L vs 117(95,127) U/L]、总住院时间[13(11,14) d vs 18(16,19) d]和住院总费用[(2.55±0.15)万元vs (3.09±0.16)万元]比较差异有统计学意义(P<0.05)。2组手术时间、鼻胆管拔除时间、腹腔引流管拔除时间、术后第1天白细胞、术后第1天总胆红素以及并发症发生率比较,差异无统计学意义(P>0.05)。结论对于因胆总管结石导致的胆源性胰腺炎,尽早行腹腔镜术中联合十二指肠镜留置鼻胆管引流在围手术期多方面更能让患者获益。

Objective Efficacy and feasibility of combined laparoscopic and duodenal endoscopic nasobiliary drainage in the early treatment of acute biliary pancreatitis.Methods Patients diagnosed with acute biliary pancreatitis,choledocholithiasis and cholecystolithiasis from June 2015 to August 2018 were selected.They were divided into early operation group(n=31) and late operation group(n=31).The operation time,postoperative intestinal function recovery time,nasobile duct removal time,abdominal drainage tube removal time,complications,total hospitalization time,cost of hospitalization,postoperative white blood cells,blood amylase and total bilirubin were compared between two groups.Results There was no recurrence of pancreatitis in both groups.There were statistically significant differences in the postoperative intestinal function recovery time[1(1,1) d vs 1(1,1) d],blood amylase on the first day postoperative[241(189,326) U/L vs 117(95,127) U/L],total hospitalization time[13(11,14) d vs 18(16,19) d]and total cost of hospitalization[(2.55±0.15) ten thousand yuan vs(3.09±0.16) ten thousand yuan]between two groups(P<0.05).There were no statistically significant differences in operation time,time of removal of nasal bile duct,time of removal of abdominal drainage tube,white blood cells and total bilirubin on the first day postoperative(P>0.05).There was no statistically significant difference in complications between the two groups(P> 0.05).Conclusion In the treatment of biliary pancreatitis,early laparoscopic combined with duodenoscopic indwalling of the nasal bile duct drainage can benefit patients in many ways during the perioperative period.