腹腔镜胆囊切除术早期治疗胆囊结石并发的急性胆源性胰腺炎的临床效果

Clinical effect of laparoscopic cholecystectomy in early treatment of cholecystolithiasis complicated with acute biliary pancreatitis

目的探讨应用腹腔镜胆囊切除术(LC)早期治疗胆囊结石并发的急性胆源性胰腺炎的临床效果。方法选择2016年1月—2018年1月安徽医科大学附属宿州医院收治的60例胆囊结石所致的急性胆源性胰腺炎患者作为研究对象,将在发病1周内行LC治疗的30例患者作为实验组;经10~14 d保守治疗好转后,于12周后延期行LC术治疗的30例患者作为对照组。比较两组住院时间,住院费用,术后并发症发生情况,胰腺炎复发情况(随访12个月),术后第1、3、7天的谷丙转氨酶+谷草转氨酶(ALT+AST)、平均碱性磷酸酶(AKP)及C-反应蛋白(CRP)值。结果实验组住院时间及住院费用明显低于对照组,差异均有统计学意义(均P<0.05)。两组术后均发生1例胆漏,但均经通畅引流后治愈;两组均未见胰腺炎复发。两组术后第3天AST+ALT、平均AKP值明显高于术后第1天及术后第7天,差异均有统计学意义(均P<0.05),两组术后第1、3、7天AST+ALT、平均AKP值比较,差异无统计学意义(P>0.05)。实验组术后第1、3、7天CRP数值均明显低于术前,差异均有统计学意义(均P<0.05)。结论应用LC早期治疗胆囊结石并发的急性胆源性胰腺炎安全有效,并明显减少住院时间及住院费用,值得推广。

Objective To investigate the clinical effect of laparoscopic cholecystectomy(LC)in the early treatment of cholecystolithiasis complicated with acute biliary pancreatitis.Methods Sixty patients with acute biliary pancreatitis caused by cholecystolithiasis admitted to Suzhou Hospital Affiliated to Anhui Medical University from January 2016 to January 2018 were selected as the study objects,and 30 patients receiving LC treatment within one week of onset were selected as the experimental group;after 10-14 days of conservative treatment,30 patients who improved and received delayed LC treatment 12 weeks later were treated as the control group.The length of hospital stay,cost of hospital stay,postoperative complications,recurrence of pancreatitis(follow-up for 12 months),alanine aminotransferase+glutamic oxalacetic transaminase(ALT+AST),average alkaline phosphatase(AKP)and C-reactive protein(CRP)values on the first,third and seventh days after surgery were compared between the two groups.Results The length and cost of hospital stay in the experimental group were significantly lower than those in the control group,and the differences were statistically significant(all P<0.05).One case of bile leakage occurred in both groups after surgery,but were all cured by unobvious drainage.No recurrence of pancreatitis was observed in both group.AST+ALT and average AKP values of the two groups on the third day after surgery were significantly higher than those of the first and seventh days after surgery,and the differences were statistically significant(all P<0.05).There was no significant difference in AST+ALT and average AKP values between the two groups on the first,third and seventh days after surgery(P>0.05).CRP value on the first,third and seventh days after surgery in the experimental group was significantly lower than that before surgery,and the differences were statistically significant(all P<0.05).Conclusion The application of laparoscopic cholecystectomy in the early treatment of cholecystolithiasis complicated with acute biliary pancreatitis is safe and effective,and significantly reduces the length and cost of hospital stay.