腹腔镜胆囊切除术治疗无黄疸急性胆源性胰腺炎95例

目的探讨腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）治疗无黄疸急性胆源性胰腺炎可行性及手术时机的选择。方法回顾性分析1996年7月～2004年7月我院收治的无黄疸急性胆源性胰腺炎95例，79例通过非手术治疗胰腺炎缓解后延期行LC，16例非手术治疗后效果不佳而急诊行LC。结果95例LC均获成功。手术时间40—328min，平均103min。术中出血量0～210ml，平均35ml。95例均行术中胆道造影，成功92例，3例失败。造影发现13例胆总管下段结石行逆行性胰胆管造影（endoscopic retrograde cholanginpancreatography，ERCP）联合内镜下十二指肠括约肌切开术（endoscopic sphincterotorny，EST），取石成功。无中转开腹及围手术期死亡，无术后出血及胆漏并发症。术后胆囊内见多发结石，以小结石、泥沙样结石多见。39例随访1个月～5年，均无胰腺炎、胆总管结石复发。结论无黄疸急性胆源性胰腺炎应尽早行LC以去除原发病因，术中造影和术后EST是其成功的重要辅助手段。

Laparoscopic cholecystectomy for acute gallstone pancreatitis without jaundice:Report of 95 cases

Objective To explore the feasibility and the selection of laparoscopic cholecystectomy(LC) for the treatment of acute gallstone pancreatitis(AGP) without jaundice.Methods Laparoscopic cholecystectomy had been performed in 95 patients with AGP accompanying no jaundice from July 1996 to July 2004 in this hospital.All of the patients had a history of conservative treatment.Selective LC was performed in 79 patients after their symptoms were relieved,while emergent LC was required in 16 patients because of failure of response to conservative treatment.Results All the operations were successfully completed.The operation time was 40~328 min(mean,103 min),and the intraoperative blood loss was 0~210 ml(mean,35 ml). Intraoperative cholangiography was carried out in all the 95 patients and succeeded in 92.Thirteen patients were found having lower common bile duct stones and then were cured with endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic spincterotomy(EST).No conversion to open operation was required.No postoperative biliary hemorrhage or leakage occurred.No fatal case was seen.Pathological examinations following operation revealed multiple small or sand-like stones in the gallbladder.Follow-up in 39 patients for 1 months ~ 5 years found no recurrence of pancreatitis or cholelithiasis.Conclusions Laparoscopic cholecystectomy should be performed as early as possible in the treatment of AGP without jaundice.Use of intraoperative cholangiography and postoperative EST should be emphasized in proper cases.