腹腔镜联合十二指肠镜早期治疗轻型急性胆源性胰腺炎57例报告

目的 探讨运用腹腔镜联合十二指肠镜早期治疗胆囊结石继发细径胆总管结石和轻型急性胆源性胰腺炎的手术方法及疗效.方法 分析在发病7 d内(早期手术组)同期行腹腔镜胆囊切除术(LC)联合十二指肠镜下乳头切开术(EST)40例患者资料,并与在胰腺炎治疗2周后(延期手术组)同期行LC联合EST 17例患者资料,观察两组的疗效.结果 同期行LC联合EST手术成功率早期手术组为92.5%,延期手术组为94.1%,两组差异无统计学意义(P>0.05).两组术后均无胆管残留结石、胰腺炎加重.无胃肠穿孔、胆管穿孔、胆漏、大出血等手术并发症,无死亡.但延期手术组的住院时间和住院费用明显高于早期手术组.(P<0.05).结论 只要选择合适的轻型急性胆源性急性胰腺炎病例,于发病7 d内同期行腹腔镜胆囊切除术及十二指肠镜下乳头切开术是安全、有效的.

Combined application of laparoscopy and duodenoscopy in early treatment of patients with mild acute biliary pancreatitis:report of 57 cases

Objective To investigate therapeutic effect of combined use of laparoscopy and duodenoscopy for mild acute biliary pancreatitis,and to summarize clinical experience and surgical skills.Methods In an early operation group,40 patients with cholecystolithiasis with thin choledochus stones and mild acute biliary pancreatitis were treated by laparoscopic cholecystectomy and duodenal endoscopic sphincterotomy 7 days after the onset of the disease(early treatment).Seventeen patients with choleystolithiasis and mild acute biliary pancreatitis underwent laparoscopic cholecystectomy and duodenal endoscopic sphincterotomy 2 weeks after conservative treatment of pancreatitis(delayed treatment).Clinical therapeutic effects were compared between the two groups.Results Combined laparoscopic cholecystectomy and duodenal endoscopic sphincterotomy was performed successfully in 92.50% of the patients in the early operation group,while it was successful in 94.12% of the patients in the delayed treatment group.There was no significant difference between the two groups(P>0.05).None of the patients had residual stones and aggravating pancreatitis in the early operation group and delayed treatment group.There were no perioperative deaths and nor severe postoperative complications,such as intestinal or bile duct perforation,biliary leakage and hemorrhea.However,the length of hospital stay and costs in the delayed treatment group was longer and higher than those in the early operation group(P>0.05).Conclusions Combined use of laparoscopy and duodenoscopy for the treatment of mild acute biliary pancreatitis is safe and effective in indicated patients within 7 days after the onset of the disease.