手术时机对胆囊结石并重症急性胆源性胰腺炎二年随访结果的影响

Impact of surgical timing on the two-year clinical outcome of patients with both severe acute biliary pancreatitis and gallstones

目的探讨手术时机对胆囊结石并重症急性胆源性胰腺炎(SABP)患者2年随访结果的影响。方法回顾性分析2016年1月至2018年3月87例胆囊结石并SABP患者病例资料。根据手术时机的不同分为两组,将入院后3 d内接受手术的42例患者纳入早期组,将胰腺炎缓解后1个月接受手术治疗的45例患者纳入延期组。采用SPSS 24.0软件进行数据处理,围术期相关指标、急性生理学和慢性健康评价量表(APAHCE-Ⅱ)评分等计量资料以(±s)表示,采用独立t检验;并发症总发生率、术后2年复发率及生存率等计数资料采用χ^2检验;Kaplan-Meier法进行术后生存分析,利用Log-Rank进行检验;P<0.05为差异有统计学意义。结果延期组手术时间、术中出血量、术后住院时间、中转开腹率均少于早期组(P<0.05)。早期组术后APAHCE-Ⅱ评分、复发率、并发症总发生率均低于延期组(P<0.0.5)。两组术后2年生存率相比,差异无统计学意义(P>0.05)。结论于入院3 d内对胆囊结石并SABP患者行腹腔镜胆囊切除术有助于减少复发及并发症风险,且对于术后预后无明显不良影响。

Objective To investigate the impact of surgical timing on the two-year clinical outcome of patients with both severe acute biliary pancreatitis and gallstones.Method A retrospective analysis were performed in 87 cases of gallbladder stones with severe acute biliary pancreatitis from January 2016 to March 2018.According to the surgical timing,42 patients underwent surgery within 3 days after admission were divided into the early surgery group,while 45 patients underwent surgery 1 month after the remission of pancreatitis were divided into the delayed surgery group.SPSS 24.0 software was used for data processing.Measurement data such as perioperative indexes and scores of APAHCE-Ⅱwere expressed as,and t test was used.Count data such as total complication rate was expressed as a percentage,andχ^2 test was used.Kaplan-Meier method was used for postoperative survival analysis and Log-Rank was used for testing.A P value of<0.05 was considered as statistically significant.Result In the delayed surgery group,the operation time,intraoperative blood loss,postoperative hospital stay,and conversion rate of laparotomy were much lower than those in the early surgery group respectively(P<0.05).The scores of postoperative APAHCE-Ⅱ,recurrence rate,and total complication rate in the early surgery group were much lower than those in the delayed surgery group respectively(P<0.05).There was no significant difference in terms of two-year survival rate between the two groups(P>0.05).Conclusion For patients with both cholecystolithiasis and severe acute gallstone pancreatitis,laparoscopic surgery within 3 days of admission could reduce the risk of recurrence and complications,and has no significant adverse effect on the prognosis.