中重度急性胆源性胰腺炎合并胰周积液行胆囊切除术的恰当时机选择

An appropriate time to perform a cholecystectomy for moderate to severe acute biliary pancreatitis with peripancreatic effusion

目的探讨中重度急性胰腺炎后延迟胆囊切除术和早期胆囊切除术的疗效。方法采用回顾性单中心研究,确定了符合纳入标准的中重度急性胰腺炎后延迟胆囊切除术和早期胆囊切除术患者各80例,对比分析患者的积液自行吸收人数、再干预及再住院人数、并发症发作率及住院时间情况。结果干预前,两组患者积液发生人数无统计学意义(P>0.05),观察组积液自行吸收人数明显多于早期胆囊切除术组(P<0.05),观察组术后需经皮穿刺引流人数、感染后穿刺人数、穿刺后感染人数均明显少于早期胆囊切除术组(P<0.05)。观察组再干预、再住院及并发症发病人数明显少于早期胆囊切除术组(P<0.001)。观察组住院时间明显少于早期胆囊切除术组(P<0.001)。结论中重度急性胆源性胰腺炎发作并出现胰腺周围积液或假性囊肿的患者选择延迟性胆囊切除术可明显提高患者预后及疗效。

Objective To investigate the therapeutic effect of delayed cholecystectomy and early cholecystectomy after moderate to severe acute pancreatitis.Methods A retrospective single-center study was conducted to identify 80 patients with delayed cholecystectomy and 80 patients with early cholecystectomy after moderate to severe acute pancreatitis with meeting the inclusion criteria.The number of patients with spontaneous absorption of fluid,the number of patients with re-intervention and re-hospitalization,the incidence of complications,and the length of stay were compared and analysed.Results Before intervention,there was no statistical significance in the number of patients with fluid accumulation between the two groups(P>0.05),the number of patients with spontaneous absorption of fluid in the observation group was significantly higher than that in the early cholecystectomy group(P<0.05),and the number of patients with postoperative percutaneous drainage,post-infection puncture,and post-puncture infection in the observation group was significantly lower than that in the early cholecystectomy group(P<0.05).The number of patients with re-intervention,re-hospitalization,and complications in observation group was significantly lower than that in early cholecystectomy group(P<0.001).The length of stay in the observation group was significantly less compared with early cholecystectomy group(P<0.001).Conclusion Delayed cholecystectomy can significantly improve the prognosis and therapeutic effect in moderate to severe acute biliary pancreatitis patients with peripancreatic effusion or pseudocyst.