早期腹腔鏡膽囊切除術在急性膽源性胰腺炎中的應用

趙暉，竺來法，曹文璽，金慧涵（南京醫(yī)科大學附屬無錫市第二人民醫(yī)院　肝膽外科，江蘇　無錫　214002）

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早期腹腔鏡膽囊切除術在急性膽源性胰腺炎中的應用

趙暉，竺來法，曹文璽，金慧涵
（南京醫(yī)科大學附屬無錫市第二人民醫(yī)院肝膽外科，江蘇無錫214002）

[摘 要]目的 探討早期腹腔鏡膽囊切除術治療急性膽源性胰腺炎的療效。方法 回顧性分析2005年1月至2014年4月我院收治的急性膽源性胰腺炎患者共136例，根據(jù)手術選擇時間，分為早期手術組（ELC組，入院后5 d內(nèi)行LC）76例和擇期手術組（ILC組，出院1個月以上擇期行LC）60例，比較兩組在手術難度、手術時間、中轉(zhuǎn)開腹率、術后并發(fā)癥發(fā)生率、住院天數(shù)和費用的不同。結(jié)果 ELC組和ILC組在手術難度、手術時間、中轉(zhuǎn)開腹率、術后并發(fā)癥發(fā)生率上并沒有統(tǒng)計學差異（P＞0.05），而ELC組的住院天數(shù)和住院費用明顯低于ILC組（P＜0.05），且ILC組有35.0%的患者在等待手術過程中因膽源性胰腺炎復發(fā)入院。結(jié)論 對于急性膽源性胰腺炎患者，早期施行LC術并沒有增加手術難度、手術時間、中轉(zhuǎn)開腹率和術后并發(fā)癥發(fā)生率，相反大大降低了住院時間和住院費用。

[關鍵詞]膽源性胰腺炎；膽囊切除術，腹腔鏡

Application of early laparoscopic cholecystectomy in acute biliary pancreatitis ZHAO Hui,ZHU Lai-fa,

CAO Wen-xi,JIN Hui-han.Department of Hepatobiliary Surgery,Wuxi No.2 People’s Hospital Affiliated to Nanjing Medical University,Wuxi,Jiangsu 214002,China

Abstract objectiveTo explore the curative effects of the early laparoscopic cholecystectomy(ELC)in acute biliary pancreatitis(ABP).MethodsA retrospective study was performed on 136 cases of ABP from Jan.2005 to Apr.2014 in our hospital.Cases of ABP underwent LC within 5 d and within 1 mon were assigned to early laparoscopic cholecystectomy group(ELC,n=76)and interval laparoscopic cholecystectomy group(ILC,n=60)respectively.The difficulty,operating time,incidence of conversion,post-operative complication rate,hospital stay and hospitalization expense were performed to compare the difference between ILC and ELC group.ResultsThere was no significant difference between ILC and ELC group in terms of the difficulty of LC,operating time,incidence of conversion and post-operative complication rate(P＞0.05).Whereas the hospital stay and hospitalization expense was significantly lower in ILC than those in ELC(P＜0.05).A total of 35.0% patients in ILC group re-admitted to hospital in waiting for surgery because of recurrence of ABP.ConclusionEarly laparoscopic cholecystectomy do not increase the difficulty of LC,operating time,incidence of conversion and postoperative complication rate for patients with ABP,on the contrary which can greatly reduce the hospital stay and hospitalization expense.

Key words acute biliary pancreatitis; laparoscopic cholecystectomy

急性膽源性胰腺炎（ABP）是由膽道疾病引起的急性胰腺炎，在我國占急性胰腺炎發(fā)病率的50%～70%[1]，臨床上除了有急性胰腺炎的特點外，通常合并膽囊結(jié)石或肝內(nèi)外膽結(jié)石。常用的治療手段包括內(nèi)科保守治療、ERCP術以及外科手術治療，但目前對于急性膽源性胰腺炎的手術時機仍有爭論。本研究回顧性分析了2005年1月至2014年4月期間我科收治的ABP患者，探討其有效的治療方法和手術時機。……