腹腔镜下胆源性急性胰腺炎患者行胆囊切除术的手术时机分析

Analysis of operative Timing of Laparoscopic Cholecystectomy for Patients with gallstone acute Pancreatitis

目的 探究腹腔镜下胆源性急性胰腺炎(GSP)患者行胆囊切除术的手术时机。方法 研究对象选取为2020年3月至2021年8月睢县人民医院收治的91例GSP患者的数据进行回顾性分析,两组患者手术方案相同,均采用腹腔镜下胆囊切除术治疗,根据患者手术时机不同做分组,发病后72 h内行手术者设为早期组,发病72 h后行手术者设为晚期组,对比两组患者的各项手术指标(术中出血量、中转开腹率、手术时间),对比两组患者的各项实验室指标恢复时间(总胆红素、血淀粉酶、尿淀粉酶、白细胞),并对比两组术后6个月内的复发率和并发症发生率。结果 早期组的术中出血量、中转开腹率与晚期组相比,差异无统计学意义(P>0.05),早期组患者的手术时间显著高于晚期组,差异有统计学意义(P<0.05);早期组的总胆红素、血淀粉酶、尿淀粉酶、白细胞恢复正常时间均显著低于晚期组,且早期组患者的复发率显著低于晚期组,差异有统计学意义(P<0.05),但两组患者的术后并发症对比,差异无统计学意义(P>0.05)。结论 早期行腹腔镜下胆囊切除术能够快速改善GSP患者的胰腺功能,减少术后复发率,且不会增加手术风险,值得临床应用。

Objective To explore the timing of laparoscopic cholecystectomy for patients with gallstone acute pancreatitis(GSP).Methods The data of 91 patients with GSP admitted to Sui County People's Hospital from March 2020 to August 2021 were retrospectively analyzed.The two groups of patients had the same surgical plan and were treated with laparoscopic cholecystectomy.They were divided into groups according to their surgical timing.Those who underwent surgery within 72 hours after the onset of the disease were assigned to the early group,while those who underwent surgery after 72 hours were assigned to the late group.Various surgical indicators(intraoperative bleeding,conversion rate to laparotomy,and operation time)of the two groups of patients were compared,the recovery time of various laboratory indicators(total bilirubin,blood amylase,urinary amylase,and white blood cells)of the two groups of patients were compared,and the recurrence rate and complication rate within 6 months after operation of the two groups were compared.Results There was no significant difference in intraoperative bleeding volume and conversion rate between the early group and the late group(P>0.05).The surgical time in the early group was significantly higher than that in the late group,with a statistically significant difference(P<0.05);The recovery time of total bilirubin,blood amylase,urinary amylase,and white blood cells in the early group was significantly lower than those in the late group,and the recurrence rate of patients in the early group was significantly lower than that in the late group,with a statistically significant difference(P<0.05).However,there was no statistically significant difference in the postoperative complications between the two groups(P>0.05).Conclusion Early laparoscopic cholecystectomy can rapidly improve pancreatic function in patients with GSP,reduce postoperative recurrence rate,and do not increase surgical risk.It is worthy of clinical application.