腹腔镜在急性胆源性胰腺炎治疗中的应用

Application of laparoscope to treatment of acute gallstone pancreatitis

目的 探讨应用腹腔镜技术治疗急性胆源性胰腺炎的可行性、有效性和手术方法。方法 1996～2 0 0 2年收治急性胆源性胰腺炎 3 9例 ,对 2 0例有急性胆道梗阻者 ,行急诊或早期腹腔镜胆囊切除术 ,胆总管切开取石T管引流、小网膜囊腔胰腺区清创引流 ,术后予腹腔灌洗。对 19例无胆道梗阻或经 3 6h保守治疗胆道梗阻缓解者 ,待胰腺炎缓解后行延期腹腔镜确定性胆道手术。结果 急诊或早期手术的 2 0例 ,18例胆总管结石取石顺利 ,2例探查阴性。延期手术 19例 ,腹腔镜手术均予术中胆道造影。 5例合并胆总管结石者行腹腔镜胆总管切开取石T管引流。 14例胆囊结石行腹腔镜胆囊切除术 (LC)。 3 9例均治愈。结论 腹腔镜手术治疗急性胆源性胰腺炎 ,体现了微创手术的优点 。

Objective To evaluate the effect and the surgical technique for treatment of acute gallstone pancreatitis(AGP) with laparoscope.Methods\ In 39 cases of AGP collected from 1996 to 2002, 20 cases complicated with the biliary obstruction received urgent or early laparoscopic cholecystectomy(LC), bile duct exploration, T-tube drainage, and drainage from lesser omental cave.Postoperative peritoneal lavage was performed. Other 19 cases, not complicated with biliary obstructive or released after 36 hours conservative treatment, selective biliary operation with laparoscopy was done after remission of AGP.Results\ In the 20 cases who received urgent operation, 18 cases with stones in the common bile duct were operated successfully.In other two cases,exploration was negative.In the 19 cases who received selective operation, 5 cases complicated with stone in common bile duct and 14 cases with cholelithiasis were all delayedly operated by LC and all performed intraoperative cholangiongraphy. All the 39 cases were cured.Conclusion\ Laparoscope is an effective treatment for AGP. Minimally invasive operation should be carried out in the cases with AGP to reduce the operative trauma.