【摘要】 目的探讨序贯微创技术在急性胆源性胰腺炎治疗中的应用价值。方法选取我院2016年6月～2017年5月收治的90例急性胆源性胰腺炎(ABP)患者作为研究对象,按照治疗方法不同分为序贯微创组(n=60)、传统开腹组(n=30),其中序贯微创方案主要包括镜下胆管造影(ERCP)+内镜下鼻胆管引流(ENBD)+内镜下乳头括约肌切开术(EST),腹腔镜胆囊切除术(LC)或LC+胆总管切开取石(LCBDE)等。观察并记录两组患者血清淀粉酶恢复时间、腹痛缓解时间、住院时间等,比较两组术后肺部感染、切口感染、胰瘘、黄疸等并发症发生情况,随访6个月统计两组胰腺炎复发情况。结果序贯微创组患者中,47例轻中度患者均一次住院治疗彻底去除病因,其中27例患者行LC治疗,2例患者行ERCP取石,15例患者行ERCP+LC治疗,3例患者行LCBDE治疗;13例重度患者中一次住院治疗彻底去除病因患者5例(38.46%),另8例(61.54%)经病情缓解后3个月内再次入院依症行序贯微创后彻底去除病因。序贯微创组内轻中度、重度患者的血清淀粉酶恢复时间、腹痛缓解时间、住院时间均较同分型传统开腹组患者明显缩短,术后并发症发生率1.67%,较传统开腹组患者的20.00%明显降低,差异均具有统计学意义(P<0.05)。随访6个月两组均未发生胰腺炎复发情况。结论序贯微创技术在急性胆源性胰腺炎治疗中具有较高的临床价值,其具有创伤小,恢复快、安全性高等优点,值得临床推广。更多还原

【Abstract】 Objective To explore the value of sequential minimally invasive technique in the treatment of acute biliary pancreatitis. Methods 90 patients with acute biliary pancreatitis(ABP) treated in our hospital from June 2016 to May 2017 were selected as the subjects, according to the different treatment methods, were divided into the sequential minimally invasive group(n=60) and the traditional open abdominal group(n=30). The sequential minimally invasive scheme mainly included endoscopic cholangiography(ERCP) + endoscopic nasobiliary drainage(ENBD) + endoscopic sphincterotomy(EST), Laparoscopic cholecystectomy(LC) or LC+ choledochotomy(LCBDE) and so on. The recovery time of serum amylase, pain relief time and hospitalization time in two groups were observed and recorded, postoperative complications such as pulmonary infection, incision infection, pancreatic fistula and jaundice in two groups were compared, the recurrence of pancreatitis in the two groups was followed up for 6 months. Results In the patients with the sequential minimally invasive group, 47 cases of mild and moderate patients were hospitalized once and thoroughly to remove the cause of the disease, among them, 27 patients were treated with LC, 2 patients were treated with ERCP, 15 patients were treated with ERCP+LC, and 3 patients were treated with LCBDE. In 13 cases of severe cases, 5 cases(38.46%) were completely removed from the hospital in one hospitalization, and the other 8 cases(61.54%) re hospitalized within 3 months after sequential minimally invasive surgery according to the disease thoroughly removed the cause. The serum amylase recovery time, abdominal pain relief time and hospitalization time in patients with mild to moderate severe disease in sequential minimally invasive group were significantly shorter than those in traditional open surgery group, the incidence of postoperative complications was 1.67% lower than that of the traditional open abdominal group(20%), and the difference was statistically significant(P<0.05). There was no recurrence of pancreatitis in the two groups of 6 months of follow-up. Conclusion Sequential minimally invasive surgery has a high clinical value in the treatment of acute biliary pancreatitis. It has the advantages of less trauma, quicker recovery and higher safety. It is worthy of clinical promotion.更多还原