胆囊结石伴发轻型急性胆源性胰腺炎手术时机选择及对复发性胆道事件的影响

The Choice of Operation Time and the Influence on Recurrent Biliary Events in Patients with Cholecystolithiasis with Mild Acute Biliary Pancreatitis

目的:探讨早期与延期腹腔镜胆囊切除术治疗胆囊结石伴发轻型急性胆源性胰腺炎(MABP)的效果及对复发性胆道事件的影响。方法:回顾性分析2017年1月-2020年12月笔者所在医院收治的46例胆囊结石伴发MABP患者的临床资料,按手术时间的不同将其分为早期组及延期组,每组23例。早期组于入院病情稳定后2周内手术,延期组于病情缓解稳定后出院,于4~6周后手术,两组均进行腹腔镜胆囊切除术。比较两组手术及住院情况、术前及术后7 d肝功能相关实验室指标、并发症、复发情况及保守治疗病情稳定后至手术期间复发性胆道事件发生情况。结果:两组手术时间、术中出血量、引流管放置率、引流管拔除时间及中转开腹率比较差异均无统计学意义(P>0.05);延期组总住院时间长于早期组,差异有统计学意义(P<0.05)。术后7 d,两组AST、ALT、ALP均较术前降低(P<0.05),但两组比较差异均无统计学意义(P>0.05)。两组均无严重并发症发生,且两组胰腺炎复发率比较差异无统计学意义(P>0.05)。延期组复发性胆道事件发生率高于早期组,差异有统计学意义(P<0.05)。结论:对于胆囊结石伴发MABP患者,早期及延期腹腔镜胆囊切除术效果、手术难度及安全性相当,但早期手术可缩短总住院时间及减少等待手术过程中复发性胆道事件的发生。

Objective:To investigate the effect of early and delayed laparoscopic cholecystectomy on cholecystolithiasis with mild acute biliary pancreatitis(MABP)and its influence on recurrent biliary events.Method:The clinical data of 46 patients with cholecystolithiasis with MABP admitted in our hospital from January 2017 to December 2020 were retrospectively analyzed.They were divided into the early group and the delayed group according to different operation time,with 23 patients in each group.The early group underwent operation within 2 weeks after the stable condition of admission,the delayed group was discharged after the stable condition,and underwent operation 4 to 6 weeks later.Laparoscopic cholecystectomy was performed in both groups.The operation and hospitalization,laboratory indexes related to liver function before and 7 d after operation,complications,recurrence and recurrent biliary events from stable condition after conservative treatment to operation were compared between the two groups.Result:There were no significant differences in the operation time,intraoperative blood loss,drainage tube placement rate,drainage tube extraction time and conversion rate to open abdomen between the two groups(P>0.05).The total hospitalization time in the delayed group was longer than that in the early group,the difference was statistically significant(P<0.05).At 7 d after operation,AST,ALT and ALP in the two groups were lower than those before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).There was no serious complications occurred in the two groups,and there was no significant difference in the recurrence rate of pancreatitis between the two groups(P>0.05).The incidence of recurrent biliary events in the delayed group was higher than that in the early group,and the difference was statistically significant(P<0.05).Conclusion:For patients with cholecystolithiasis with MABP,the effect,surgical difficulty and safety of early and delayed laparoscopic cholecystectomy are similar,but early operation can shorten the total hospitalization time and reduce the occurrence of recurrent biliary events during waiting for operation.