早期腹腔镜胆囊切除术治疗老年轻症急性胆源性胰腺炎

目的探讨老年轻症急性胆源性胰腺炎(ABP)行腹腔镜胆囊切除术(LC)的安全性和手术时机。方法对解放军413医院2008年1月至2016年6月收治的老年轻症ABP伴胆囊结石76例进行回顾性分析,患者被分成两组:早期手术组(发病48h内行LC)49例和择期手术组(发病2w~4w内行LC)27例。观察两组血清胆红素、血淀粉酶、丙氨酰氨基转移酶、天门冬氨酸氨基转移酶变化,手术相关资料和总住院时间。结果术后第3天血清胆红素和血淀粉酶差异有统计学意义(t=7.766,t=11.49,P0.05),丙氨酰氨基转移酶和天门冬氨酸氨基转移酶差异无统计学意义(t=1.670,t=1.064,P0.05)。两组总住院时间差异有统计学意义(t=4.300,P0.05),手术时间、中转开腹率和切口感染发生率差异无统计学意义(t=1.544,χ~2=0.204,χ~2=0.007,P0.05)。结论早期和择期LC治疗老年轻症ABP疗效和风险无明显差异,从治疗的彻底性出发,在患者身体状态条件允许的情况下可优先选择早期LC术。

Early LC treatment for senile mild acute biliary pancreatitis

Objective To investigate the safety and operation timing of LC in treating senile mild acute biliary pancreatitis.Methods In this study,76 patients with senile mild acute biliary pancreatitis and cholecystolithiasis were divided into two groups.Patients in early operating group received LC within 48 hours of onset,delayed operating group received operation at 10 days to four weeks.The two groups were evaluated by bilirubin,blood amylase,alanine aminotransferase,aspartate aminotransferase within 48 hours of onset and on postoperative day 3,operation related data and hospitalization time.Results Bilirubin and blood amylase were lower in delayed group than in early group (t =7.766,t =11.49,P ＜ 0.05),while there were no difference in the two groups in alanine and aspartate aminotransferase(t =1.670,t =1.064,P ＞ 0.05)at 3 d after the operation.There was significant difference in the hospitalization time (t =4.300,P ＜ 0.05),there were no significant difference in operation time,rate of converting to laparotomy and incision infection(t =1.544,x2 =0.204,x2 =0.007,P ＞ 0.05).Conclusions The clinical curative effects of early and delayed LC on senile mild acute biliary pancreatitis showed no significant differences,the recurrence rate of acute pancreatitis within 6 months revealed that early LC may be superot to the delaged procelume.