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腹腔镜胆总管探查内置管引流术治疗急性胆源性胰腺炎的临床观察
Clinical effect of laparoscopic common bile duct exploration combined with endobiliary drainage in treatment of acute biliary pancreatitis
文章发布日期:2015年04月15日  来源:  作者:孙金春  点击次数:1735次  下载次数:326次

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【摘要】:目的探讨腹腔镜胆总管探查内置管引流术治疗急性胆源性胰腺炎的临床疗效。 方法回顾性分析2012年1月-2014年5月收治的90例急性胆源性胰腺炎患者,其中腹腔镜胆总管探查内置管引流术(腹腔镜组)42例,经内镜逆行胰胆管造影(ERCP)联合十二指肠乳头括约肌切开术(EST)(ERCP组)48例,比较两组患者手术情况、术前及术后的白细胞(WBC)、TBil、ALT、C-反应蛋白(CRP)水平的变化及随访情况。计量资料组间比较用t检验,计数资料组间比较采用χ2检验。结果两组患者的手术时间、术中出血量、住院费用及手术相关并发症差异均无统计学意义(P值均>0.05)。腹腔镜组及ERCP组术后第1、3、7 d血清WBC、TBil、ALT及CRP水平较术前均有所下降,但两组均只有术后第3、7 d与术前比较差异有统计学意义(P值均<0.05)。腹腔镜组术后第3 d血清WBC及CRP水平明显低于ERCP组,差异有统计学意义(P值均<0.05);两组患者间其他同一时间点术后各指标的差异均无统计学意义(P值均>0.05)。随访6个月,ERCP组反流性胆管炎发生率为6.25%(3/48),腹腔镜组无并发症发生(χ2=2.716,P=0.099)。 结论腹腔镜胆总管探查内置管引流术治疗胆源性胰腺炎是安全可行的,并可以保留Oddi括约肌功能。
【Abstract】:ObjectiveTo evaluate the clinical effect of laparoscopic common bile duct exploration combined with endobiliary drainage in the treatment of acute biliary pancreatitis. MethodsA retrospective analysis was performed on the clinical data of 90 patients with acute biliary pancreatitis admitted to our hospital from January 2012 to May 2014. Among them, 42 patients received laparoscopic common bile duct exploration combined with endobiliary drainage (laparoscopic group), and 48 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) combined with endoscopic sphincterotomy (ERCP group). The operation situation, changes in white blood cell (WBC) count, total bilirubin (TBil), alanine aminotransferase (ALT), and C-reactive protein (CRP) after operation, and follow-up results were analyzed. Comparison of continuous data between the two groups was made by t test, while comparison of categorical data was made by chi-square test. ResultsThere were no significant differences in operation time, intraoperative blood loss, hospitalization expenses, and the incidence of complications between the two groups (all P>0.05). On the 1st, 3rd, and 7th days after operation, the two groups had reduced WBC count and serum levels of TBil, ALT, and CRP, but the reduction was significant only on the 3rd and 7th days in both groups (all P<0.05). On the 3rd day, the laparoscopic group had significantly lower WBC count and CRP level than the ERCP group (both P<0.05), but none of all the indices showed significant differences between the two groups at other time points (all P>0.05). In the 6-month follow-up, the incidence of regurgitation cholangitis in the ERCP group was 6.25% (3/48), but no complications were found in the laparoscopic group (χ2=2.716, P=0.099). ConclusionLaparoscopic common bile duct exploration combined with endobiliary drainage is safe and feasible for acute biliary pancreatitis, and it can retain the function of the Oddi′s sphincter.
【关键字】:胰腺炎;胆汁淤积;胆管炎;腹腔镜检查;引流术
【Key words】:pancreatitis; cholestasis; cholangitis; laparoscopy; drainage
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