急性胆源性胰腺炎的微创治疗方式探讨

目的:探讨急性胆源性胰腺炎的适宜微创治疗方式。方法:回顾性分析2006年1月-2011年12月年收治的128例急性胆源性胰腺炎的临床资料,采用腹腔镜、内镜进行微创治疗。结果:128例急性胆源性胰腺炎中非梗阻型80例,梗阻型48例。29例患者行急诊内镜治疗,其中16例急诊内镜下未能完全去除梗阻因素或合并有胆囊结石,于急性胰腺炎缓解后2～4周行二期内镜治疗或腹腔镜手术;12例行急诊腹腔镜手术,3例残余肝外胆管结石,于术后2周行二期内镜或6～8周行胆道镜检查取石。本组无死亡病例。急诊内镜治疗无消化道出血、肠穿孔等内镜操作相关并发症。术后出现胆漏2例、肺部感染2例,均经保守治疗后痊愈。择期腹腔镜手术或腹腔镜加内镜手术87例,3例中转开腹。全组病例随访6个月～5年,4例出现急性胰腺炎复发,8例有返流性胆管炎症状,保守治疗后好转。结论:腹腔镜、内镜单独或联合应用是急性胆源性胰腺炎的有效微创治疗手段,值得临床推广应用。

Minimally Invasive Treatment for Acute Biliary Pancreatitis

Objective:To investigate the minimally invasive treatment for acute biliary pancreatitis.Methods:The clinical data of 128 patients with acute biliary pancreatitis treated in our hospital were retrospectively analyzed.Results:There were 80 patients with bile duct obstruction.29 cases received emergency endoscopic therapy,among them,second-stage endoscopic or laparoscopic treatment were performed in 16 cases because of obstructive factor or stones.12 cases underwent emergency laparoscopic procedures.Due to residual stones,3 cases were performed second-stage endoscopic or choledochoscope treatment.No death occurred in our group.There were no endoscope related severe complications or aggrevated symptoms.Postoperative complications,including bile leakage in 2 cases,lung infection in 2 cases,were cured.Selective operations were performed in 87 cases and 3 cases converted to laparotomy.In 6~60 months follow-up,recurrent pancreatitis were seen in 4 cases and reflux cholangitis in 8 cases.The conservative treatment was effectual.Conclusion:Early endoscopic or/and laparoscopic therapy is a safe and effective minimal method for acute biliary pancreatitis and has its clinical application value.