腹腔镜联合十二指肠镜手术治疗急性重症胆源性胰腺炎的临床研究

目的:探讨腹腔镜联合十二指肠镜手术治疗急性重症胆源性胰腺炎(ABP)的疗效及安全性。方法:方法:58例ABP患者根据治疗方法分为观察组(n=28)行腹腔镜及十二指肠镜手术和对照组(n=30)行传统开腹手术,比较2组手术情况、病死率及并发症发生率。结果:2组均成功完成手术,术中无死亡病例。观察组3例因十二指肠镜术中插管困难,3例乳头部结石嵌顿,2例有残余结石,行第2次择期十二指肠镜手术,8例合并胆总管结石。对照组1例术后3 d病情恶化,行手术清创引流,6例有残余结石。观察组和对照组病死率分别为3.57%和16.67%(P>0.05),观察组住院时间显著短于对照组(P<0.01)。观察组并发症发生率14.29%,显著低于对照组的43.33%(P<0.01)。结论:腹腔镜联合十二指肠镜手术治疗ABP疗效较为理想,病死率低,术后并发症少,可促进病情康复,缩短住院时间。

Clinical study on laparoscope combined with duodenoscope in treatment of patients with severe acute biliary pancreatitis

Objective:To explore the clinical efficacy and safety of laparoscope combined with duodenoscope in the treatment of patients with severe acute biliary pancreatitis (ABP).Methods:A total of 58 patients with ABP were randomly divided into observation group (n =28)treated with aparoscope combined with duodenoscope and control group (n =30)with conventional laparotomy.Surgical conditions,mortality rate and rate of complications were compared between two groups.Results:Patients of both groups finished the surgery completely and none died.In observation group,3 patients with difficulty of intubation due to duodenoscope,3 with incarcerated gallstones in papilla and 2 with residual lithiasis received secondary duodenoscope in selective days,while 8 were complicated with cho-ledocholithiasis.In control group,1 patient who had disease aggravation 3 d after operation was given surgical debridement drainage and 6 had residual lithiasis.The mortality rates of observation and control groups were 3.57% and 16.67%,respectively (P >0.05 ),and observation group was markedly shorter in hospital stays than control group (P <0.01 ).The rate of complications was 14.29% in ob-servation group,prominently lower than the 43.33% in control group (P <0.01 )Conclusion:Laparoscope combined with duodeno-scope is an ideal surgical method for patients with ABP,which can has lower mortality rate,reduce postoperative complications,promote disease recovery and shorten hospital stays.