胆囊结石合并胰腺炎手术时机的选择及治疗效果比较

Timing of Cholecystolithiasis Complicated with Pancreatitis and the Comparison of Treatment Effect

目的:探讨胆囊结石合并胰腺炎手术时机的选择及治疗效果。方法:选取2018年7月-2020年7月收治的胆囊结石合并胰腺炎患者105例,按手术时机不同分为两组,对照组(n=70)延期手术治疗,研究组(n=35)早期手术治疗。比较两组不同时点中性粒细胞比例、碱性磷酸酶(ALP)、谷草转氨酶(AST)、谷丙转氨酶(AST)、C反应蛋白(CRP)、白细胞计数变化情况,比较两组住院时间、手术出血量、手术时间、中转开腹率、并发症发生率。结果:术后1、3 d,两组间中性粒细胞比例、ALP、ALT、AST、CRP、白细胞计数对比,差异无统计学意义(P>0.05),术后7 d,两组间ALP、ALT、AST水平对比,差异无统计学意义(P>0.05),但研究组术后7 d的中性粒细胞比例、CRP、白细胞计数水平均低于对照组(P<0.05);研究组总住院时间短于对照组(P<0.05),两组间手术出血量、手术时间、中转开腹率对比,差异无统计学意义(P>0.05);两组继发胆总管结石、切口感染、肺不张、胆囊窝积液伴感染等并发症发生率对比,差异无统计学意义(P>0.05)。结论:胆囊结石合并胰腺炎患者应用腹腔镜胆囊切除术治疗时,延期手术和早期手术术后均能获得较好的治疗效果,早期术后更能减少患者住院费用,降低对肝功能的损伤,减轻手术应激反应,降低术后并发症,具有积极推广意义。

Objective:To investigate and the surgical timing of cholecystolithiasis complicated with pancreatitis and compare the treatment effect.Method:A total of 105 patients with cholecystolithiasis complicated with pancreatitis from July 2018 to July 2020 were selected and divided into two groups according to different operation time.The control group received delayed operation,and the study group received early operation.The changes of neutrophil ratio,alkaline phosphatase (ALP),aspartate aminotransferase (AST),alanine aminotransferase (ALT),C-reactive protein (CRP) and white blood cell count were compared between the two groups at different time points.The hospitalization time,operation bleeding volume,operation time,conversion rate to laparotomy and complication rate were compared between the two groups.Result:There were no significant differences in the proportion of neutrophils,ALP,ALT,AST,CRP and leukocyte count between the two groups at 1 and 3 days after operation (P>0.05),and there were no significant differences in the levels of ALP,ALT and AST between the two groups at 7 days after operation (P>0.05),but the proportion of neutrophils,CRP and leukocyte count in the study group at 7 days after operation were lower than those in the control group (P<0.05).The total hospital stay in the study group was shorter than that in the control group (P<0.05).There was no significant difference in the amount of surgical bleeding,operation time and conversion rate between the two groups (P>0.05).There was no significant difference in the incidence of complications such as common bile duct stones,incision infection,atelectasis and gallbladder fossa effusion with infection between the two groups (P>0.05).Conclusion:When patients with gallstone complicated with pancreatitis are treated with laparoscopic cholecystectomy,delayed operation and early postoperative can obtain better treatment results.Early postoperative can reduce hospitalization expenses,reduce damage to liver function,reduce surgical stress response and reduce postoperative complications,which has positive popularization significance.