胆囊结石并发胆源性胰腺炎行腹腔镜胆囊切除术手术时机的探讨

目的 探讨胆囊结石并发急性胆源性胰腺炎（acute biliary pancreatitis，ABP）患者行LC于术的最佳时机。方法 回顾性分析我院1997年2月～2004年12月间收治的肌囊结白并发ABP行LC的63例患者的临床资料，其中轻症急性胰腺炎（mild acute pancreatitis，MAP）42例，重症急性胰腺炎（severe acute pancreatitis，SAP）21例，均先行持续胃肠减压、抑制胰液分泌等保守治疗。根据行LC的手术时间，MAP患者分为A组（发病后7d内丁术暂）24例，B组（7d后手术者）18例；SAP患者分为C组（发病3周内手术者）5例，D组（3周后手术肯）16例比较MAP、SAP患者各组间中转开腹手术、术后并发症及死亡情况、住院时间及费用等。结果 MAP患者中，除A组在住院时间及住院费用上低于B组外（P〈0．05），两组中转开腹手术、术后并发症及死亡情况无显著差异（P〉0．05）；SAP患者中，D组各项指标均优于C组（P〈0．05）。1例发病后3周内手术的SAP患者，术后炎症加重致MOSF死亡。结论 对胆囊结石并发ABP行LC手术，MAP存发病后7d内手术是安全的，SAP最好在发病3周以上行LC手术。

Optimal Time of Laparoscopic Cholecystectomy in Treatment of Biliary Pancreatitis Secondary to Gallbladder Stone

Objective To investigate the optimal time of laparoscopic choleystectomy (LC) for acute biliary pancreatitis (ABP). Methods 63 cases of ABP underwent LC from February 1997 to December 2004 were retrospectively reviewed, including 42 cases of mild acute pancreatitis (MAP) and 21 cases of severe acute pancreatitis (SAP). Conservative treatment was administered in all cases as gastrointestinal decompression and pancreatic excretion inhibition. Cases of MAP underwent LC within 7 days and after 7 days were assigned to group A (n=24) and group B (n=18) respectively. Cases of SAP underwent LC within 3 weeks and after 3 weeks were assigned to group C (n=5) and D (n=16) respectively. The incidence of conversing to open surgery, morbidity, mortality, hospital stay and cost were compared between each group. Results There was no significant difference between group A and B in terms of the rate of conversing to open surgery, morbidity and mortality. Whereas the hospital stay and cost were significantly lower in group A than in group B. When compared with group C, group D showed significantly better result in terms of all the studied factors (P<0.05). One death occurred within 3 weeks in group C due to MOSF. Conclusion The optimal time of LC in treatment of ABP should be within 7 days in MAP cases and after 3 weeks in SAP cases.