急性胆源性胰腺炎患者胆囊切除时机的选择分析

Reasonable timing of cholecystectomy in patients with acute gallstone pancreatitis

目的:探讨急性胆源性胰腺炎患者胆囊切除时机的合理选择。方法:回顾性分析2012年1月至2017年1月汕头大学医学院第一附属医院收治的235例急性胆源性胰腺炎患者的临床资料,按照是否存在胆道梗阻分为非梗阻型组(110例)和梗阻型组(125例),比较两组患者术后并发症发生率、住院时间、APACHE II计分及死亡率等,总结胆囊切除时机所遵循的原则。结果:与延期手术相比,早期手术可缩短非梗阻型患者住院时间,但会增加并发症发生率(P<0.05);会增加梗阻型患者住院时间,但可降低并发症发生率和死亡率(P<0.05)。结论:急性胆源性胰腺炎患者胆囊切除时机的选择直接影响手术预后,早期宜保守治疗,结合患者个体情况在合适时机切除胆囊,以降低并发症发生率,改善治疗效果。

Objective: To determine the reasonable timing of cholecystectomy in patients with acute gallstone pancreatitis. Methods: A review was conducted on the clinical data of 235 patients with acute gallstone pancreatitis admitted to the First Affiliated Hospital of Shantou University Medical College between January 2012 and January 2017. According to presence of biliary obstruction,the patients were divided into the non-obstruction group( n = 110) and obstruction group( n = 125). The incidence of postoperative complications,length of hospital stay,APACHE II score and mortality were compared between the two groups. Thereby,we summarized on the guidance principle for the timing of cholecystectomy in these patients. Results: Compared with delayed surgery,early surgery could shorten the length of hospital stay but meanwhile increase the incidence of postoperative complications in non-obstructive patients,( P<0.05),and increased length of hospital stay but meanwhile reduce the incidence of postoperative complications and mortality in obstructive patients( P < 0. 05). Conclusion: The timing of cholecystectomy in patients with acute gallstone pancreatitis relates directly to the outcomes of surgery.Conservative treatment is recommended during the early onset of disease. Then,according to the individual patient condition,cholecystectomy may be performed at a reasonably selected time,so as to reduce the incidence of complications and improve the therapeutic efficacy.