专题研究(Monographic Study)

梗阻型轻症急性胆源性胰腺炎不同治疗方式的疗效分析

Published at: 2016年第25卷第3期

柳志 1 , 王俊 1 , 吕品 1 , 蒋波 1 , 段小辉 1 , 张红辉 1 , 陈勇治 1
1 湖南师范大学第一附属医院/ 湖南省人民医院 肝胆外科,湖南 长沙 410005
通讯作者 俊 王 Email: 13973120355@139.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.03.003
基金:
湖南省科学技术厅科技计划资助项目 2014FJ3033
湖南省教育厅高校科研计划资助项目 15C0836
湖南省卫生厅科研计划资助项目 B2012-079

摘要

目的:探讨梗阻型轻症急性胆源性胰腺炎(MABP)的最佳治疗方案。方法:回顾性分析2008—2014 年收治的132 例梗阻型MABP 患者的临床资料。其中35 例行以内镜逆行胆胰管造影为基础的微创治疗(内镜组),43 例行腹腔镜下胆囊切除、胆总管探查术(腹腔镜组),54 例行开腹手术(开腹组)。比较各组的相关临床指标。结果:内镜组、腹腔镜组、开腹组间的腹痛缓解时间(3.31 d vs. 3.84 d vs. 7.65 d)、白细胞恢复正常时间(4.20 d vs. 5.35 d vs. 8.72 d)差异均有统计学意义(均P<0.05);内镜组与腹腔镜组的血淀粉酶恢复正常时间(3.26 d vs. 3.53 d)、住院时间(9.49 d vs. 9.30 d)差异无统计学意义(均P>0.05),但均短于开腹组(4.35 d、9.30 d)(均P<0.05)。3 组的治愈率均为100%,均无死亡病例,并发症发生率差异无统计学意义(P>0.05);内镜组术后1 年内胰腺炎复发率(42.86%)明显高于腹腔镜组(0.00%)和开腹组(1.85%)(均P<0.05),但后两组间差异无统计学意义(P>0.05)。结论:对于梗阻型MABP,在大多数情况下,腹腔镜途径是解除胆道梗阻的首选方法。


Efficacy analysis of different treatment methods for obstructive mild acute biliary pancreatitis

Abstract

Objective: To investigate the best treatment choice for obstructive mild acute biliary pancreatitis (MABP). Methods: The clinical data of 132 patients with obstructive MABP treated during 2008 to 2014 were retrospectively analyzed. Of the patients, 35 cases underwent minimally invasive surgery based on endoscopic retrograde cholangiopancreatography (endoscopic group), 43 cases underwent laparoscopic cholecystectomy and common bile duct exploration (laparoscopic group) and 54 cases underwent open surgery (laparotomy group). The relevant clinical variable among the three groups were compared. Results: In endoscopic group, laparoscopic group and laparotomy group, the time to relief of abdominal pain (3.31 d vs. 3.84 d vs. 7.65 d) and time for white blood cells to return to normal level (4.20 d vs. 5.35 d vs. 8.72 d) were statistically different between each of them (all P<0.05); in endoscopic group and laparoscopic group, the time for recovery of blood amylase (3.26 d vs. 3.53 d) and length of hospital stay (9.49 d vs. 9.30 d) showed no statistical difference (both P>0.05), but were all shorter than that in laparotomy group (4.35 d and 9.30 d) (both P<0.05). In the 3 groups, the cure rate was 100% and no death occurred, and the incidence of complications showed no statistical difference between them (P>0.05); the incidence of recurrent pancreatitis within one year after operation in endoscopic group (42.86%) was significantly higher than that in laparoscopic group (0.00%) and laparotomy group (1.85%) (both P<0.05), but showed no statistical difference between the latter two groups (P>0.05). Conclusion: For most cases of obstruction MABP, the laparoscopic approach is the preferred method to relieve biliary obstruction.


comments powered by Disqus

全文

引用

引用本文: 志 柳, 俊 王, 品 吕, 波 蒋, 小辉 段, 红辉 张, 勇治 陈. 梗阻型轻症急性胆源性胰腺炎不同治疗方式的疗效分析[J]. 中国普通外科杂志, 2016, 25(3): 321-326.
Cite this article as: LIU Zhi, WANG Jun, Lv Pin, JIANG Bo, DUAN Xiaohui, ZHANG Honghui, CHEN Yongzhi . Efficacy analysis of different treatment methods for obstructive mild acute biliary pancreatitis[J]. Chin J Gen Surg, 2016, 25(3): 321-326.