轻症急性胆源性胰腺炎行腹腔镜胆囊切除术的最佳手术时机研究

Abstract
Figure/Table
References
Related Citation (15)

Download: PDF (715 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To investigate the best timing of laparoscopic cholecystectomy for mild acute gallstone pancreatitis.Methods Totally 150 cases of mild acute biliary pancreatitis(MABP) admitted to the First Hospital of Shanxi Medical University between January 1, 2016 to June 30, 2018 were enrolled.All these cases underwent laparoscopic cholecystectomy(LC). According to the time of start of surgery,the patients were divided into three groups: group A (emergency operation)(＜72 h, n=10),group B (early operation) (72 h-2 weeks, n=50) and group C (deferred operation)(＞2 weeks, n=90). The intraoperative blood loss volume,duration of surgery,length of hospital stay, medical expense,such biochemical indexes as levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin (TBIL)before operation and 3d after operation,the incidence of postoperative complications(pseudocyst and pancreatic abscess), recovery and recurrence of pancreatitis were analyzed.Results Group C had the longest hospital stay[36(34,37)d] and the highest medical expense[76,000(74,000 and 77,000)yuan], while group A had the shortest hospital stay[15(14,16)d] and the minimum medical expense[36,000(34,000 and 37,300)yuan], The duration of surgery of the three groups was[(48.08±7.52)min,(61.16±6.35)min and(74.86±8.68)min respectively](P<0.05).Levels of ALT,AST,TBIL,amylase, lipase, blood glucose and hemameba decreased significantly 3 d after operation, but the level of blood calcium was higher than before(P<0.05). There was significant difference in levels of ALT and AST 3 d after operation between these groups (P<0.05). but there was no significant difference in the incidence of postoperative complications or the rate of recurrence between these groups.Conclusions Mild biliary AP patients should be operated on within 72 hours of onset.

Key words： acute biliary pancreatitis laparoscopic cholecystectomy timing of operation

Received: 20 November 2018

ZTFLH:

R657.51

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors

Cite this article:

URL:

http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2019/V30/I6/484

[1]	余硕,张阳德,张伦.不同手术时机治疗老年胆源性急性胰腺炎的疗效比较[J].中国老年学杂志,2013,3(8):173-174.
[2]	Banks P A,Bollen T I,Dervenis C,et al.Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62:102-111.
[3]	潘登. 不同时机腹腔镜胆囊切除术治疗胆源性急性胰腺炎的临床效果[J]. 中国医药,2018,7(13):1034-1037.
[4]	冯延平,史东利. 轻型急性胆源性胰腺炎一期行腹腔镜胆囊切除术可行性及安全性观察[J]. 海南医学, 2017, 28(7): 1154-1156.
[5]	中华医学会消化病学分会胰腺疾病学组,《中华胰腺病杂志》编辑委员会,《中华消化杂志》编辑委员会.中国急性胰腺炎诊治指南(2013年,上海)[J]. 临床肝胆病杂志, 2013, 29(9):656-660.
[6]	冯章东,刘佐军.早期与延期腹腔镜胆囊切除术治疗轻型急性胆源性胰腺炎临床疗效分析[J]. 临床军医杂志, 2018, 46(2): 213-215.
[7]	Zhu H M,Zhang M,Li B Y,et al.Relevance between small intestinal bacterial overgrowth and complications of severe acute pancreatitis[J]. Chin Med,2017,12(6):884-887.
[8]	Gao S P,Li Z J,Zhang L,et al.Laparoscopic cholecystectomy operation timing of cholecvstolithiasis complicated with biliary pancreatitis[J].Guide Chin Med,2014,12(17):32-33.
[9]	杨伟,陈洁静,倪庆. 急性胆源性胰腺炎行手术治疗的时机及疗效分析[J]. 国际外科学杂志, 2016, 43( 6): 371-374.
[10]	王云龙. 浅谈急性胆源性胰腺炎患者腹腔镜胆囊切除手术治疗[J]. 当代医学, 2016, 22(22): 63 -64.
[11]	郭晓钟,张永国,吴春燕.重症急性胰腺炎的非药物治疗[J]. 临床内科杂志,2015,32(2):77-79.
[12]	林健群,洪建文,杨熙.胆源性胰腺炎240例治疗体会[J].中国现代普通外科进展,2014,17(8):657-659.
[13]	Mador B D, Panton O N, Hameed S M. Early versus delayed cholecystectomy following endoscopic sphincterotomy for mild biliary pancreatitis [J]. Surg Endosc, 2014. 28(12):3337-3342.
[14]	Nebiker C A, Frey D M, Hamel C T, et al. Early versus delayed cholecystectomy cystectomy in patientswith biliary acutepancreatitis[J]. Surgery, 2009, 145(3): 260-264.
[15]	王建良,孔雷,韩峰,等.104例胆源性急性胰腺炎手术治疗时机探讨[J].肝胆胰外科杂志,2008,20(3):190-192.
[16]	朱鸿明,张玫,李邦一,等.小肠细菌过度生长与重症急性胰腺炎并发症相关性探讨[J].中国医药,2017,12(6):884-887.
[17]	包文中,孟翔凌,李良,等.胆囊结石合并急性胰腺炎患者早期腹腔镜胆囊切除术的临床疗效[J].中华肝胆外科杂志,2014,20(2):89-91.
[18]	肖俊,陈海川,余海波,等.胆囊结石伴急性胆源性胰腺炎的微创治疗[J]. 中国微创外科杂志, 2014, 14(5): 399-401.
[19]	Alper B, Mehmet T, Ersin G, et al. Early versus delayedlaparoscopic cholecystectomy for acute cholecystitis: a prospective,randomized study[J]. Int Surg, 2014, 99(1): 56-61.
[20]	Bouwense S A, Besselink M G, Brunschot S, et al. Pancreatitis of biliary origin, optimaltiming of cholecystectom (PONCHO trial): study protocol for a randomized controlled trial[J]. Trials, 2012, 13: 225.
[21]	Beninato T, Kleiman D A, Soni A, et al. Expanding the indications for singleincision loaparoscopic cholecysteetomy to all patients with biliary disease: is it safe?[J]. Surg Laparosc Endosc Percutan Tech,2015,25(1):10-14.
[22]	陈胜,吴卫泽,李能平.轻症胆源性胰腺炎腹腔镜胆囊切除手术时机的探讨[J].中华胰腺病杂志, 2016, 16(5): 326-330.
[23]	夏中平,闻久辉. 轻度胆源性急性胰腺炎患者胆囊切除时机探讨[J].中国基层医药, 2017, 24(11): 1696-1698.