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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 606 -609. doi: 10.3877/cma.j.issn.1674-3946.2019.06.020.

所属专题： 文献；

论著

腹腔镜技术用于胆囊结石致急性胰腺炎手术治疗的安全性及手术时机选取
王迎春1, 毛忠琦2, 吴祥秀1, 陈昕2,†(), 刘希宁3   
  1. 1. 215331　江苏省昆山市第四人民医院普外科
    2. 215000　苏州大学附属第一医院普外科
    3. 063000　开滦总医院普外科
  • 收稿日期:2019-09-20 出版日期:2019-12-26
  • 通信作者: 陈昕

The safety and timing of surgery of laparoscopic surgery for treatment of acute pancreatitis caused by gallstones

Yingchun Wang1, Zhongqi Mao2, Xiangxiu Wu1, Xin Chen2,†(), Xining Liu3   

  1. 1. Department of General Surgery, Kunshan Fourth People’s Hospital, Jiangsu Province, 215331
    2. General Surgery 215000, First Affiliated Hospital of Suzhou University
    3. Department of General Surgery, Kailuan General Hospital, 063000
  • Received:2019-09-20 Published:2019-12-26
  • Corresponding author: Xin Chen
  • About author:
    Corresponding author: Chen Xi, Email:
  • Supported by:
    Hebei Provincial Health Planning Commission Project(No. 20171426)
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王迎春, 毛忠琦, 吴祥秀, 陈昕, 刘希宁. 腹腔镜技术用于胆囊结石致急性胰腺炎手术治疗的安全性及手术时机选取[J/OL]. 中华普外科手术学杂志(电子版), 2019, 13(06): 606-609.

Yingchun Wang, Zhongqi Mao, Xiangxiu Wu, Xin Chen, Xining Liu. The safety and timing of surgery of laparoscopic surgery for treatment of acute pancreatitis caused by gallstones[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(06): 606-609.

目的

探讨腹腔镜技术用于胆囊结石致急性胰腺炎手术治疗的安全性及手术时机。

方法

回顾性选取94例胆囊结石致急性胰腺炎患者的临床资料，按照患者发病距手术时间将患者分为早期手术组(48h内)和延期手术组(48h后)，分别52例，42例。数据应用统计学软件SPSS22.0处理。手术相关指标采用(±s)表示，独立t检验；镇痛药物使用率、完全切除率、中转开腹率及并发症发生率采用χ2检验；P<0.05为差异有统计学意义。

结果

早期组患者的手术时间、术中出血量、术后排气时间、住院时间及住院费用均少于延期组(均P<0.05)。早期组镇痛药物使用率及中转开腹率均低于延期组(均P<0.05)，而完全切除率高于延期组(P<0.05)。两组患者术后IL－6及CRP水平均高于术前、IL－10低于术前(均P<0.05)，且早期组IL－6及CRP水平均低于延期组、IL－10高于延期组(均P<0.05)。早期组并发症发生率为3.8%明显低于延期组并发症发生率为19.0%(P<0.05)。

结论

胆囊结石致急性胰腺炎行早期腹腔镜手术，可降低术后镇痛药物使用率、中转开腹率及并发症发生率，安全性较高，且术后机体应激反应较小，临床效果优于延期手术，值得推广应用。

关键词: 胰腺炎，急性坏死性, 胆囊结石病, 腹腔镜, 安全
Objective

To investigate the safety and timing of laparoscopic surgery for the treatment of acute pancreatitis caused by gallstones.

Methods

The clinical data of 94 patients with acute pancreatitis caused by gallstones were retrospectively selected. The patients were divided into early operation group (within 48 hours) and delayed operation group (after 48 hours) according to the time of surgery, 52 and 42 cases respectively. Data analysis was performed by statistical software SPSS22.0. Surgery-related indicators were expressed by (±s) and compared with independently t test. The rate of using analgesics, the rate of complete resection, the rate of conversion to laparotomy and the incidence of complications werecompared by χ2 test, P<0.05 indicated the difference was statistically significant.

Results

The operation time, intraoperative blood loss, postoperative venting time, hospitalization time and the cost of hospitalization of the early operation group were less than those of the delayed operation group (P<0.05). The analgesic drug use rate and conversion rate were lower in the early operation group than those in the delayed operation group (P<0.05), and the complete resection rate was higher in the early operation group than that in the delayed operation group (P<0.05). After surgery, the levels of IL-6 and CRP in the two groups were higher than those before surgery and IL-10 was lower than that before surgery (P<0.05), and the IL-6 and CRP levels in the early group were lower than those in the delayed group, and IL-10 was higher than that in the delayed group (all P<0.05). The incidence of complications in the early group was 3.8%, which was significantly lower than that in the delayed group (19.0%) (P<0.05).

Conclusion

Early laparoscopic surgery for acute pancreatitis caused by gallstones can reduce the postoperative analgesic drug use rate, conversion rate and complication rate, the safety is higher, the body’s stress response was less after surgery, and the clinical effect is better than delayed surgery. It is worthy of popularization and application.

Key words: Pancreatitis, acute necrotizing, Cholecystolithiasis, Laparoscopes, Safety
表1 94例胆囊结石致急性胰腺炎患者不同手术时间两组患者基本资料比较[(±s)、例]
组别 例数 年龄(岁) 体重(kg) 性别 胰腺炎分级
男/女 轻度/重度
早期组 52 43.6±5.7 64.4±8.5 33/19 41/11
延期组 42 45.4±4.3 61.6±9.2 28/14 32/10
t/χ2值 ? －1.6934 1.5304 0.7462 0.0944
P值 ? >0.05 >0.05 >0.05 >0.05
表2 94例胆囊结石致急性胰腺炎患者不同手术时间两组患者术中术后指标比较(±s)
组别 手术时间(min) 术中出血量(ml) 术后排气时间(d) 住院时间(d) 住院费用(万元)
早期组 59.6±8.2 11.4±1.5 1.8±0.6 2.8±0.6 0.9±0.5
延期组 68.2±4.8 20.3±2.6 2.7±0.8 4.6±0.7 1.7±0.4
t值 －6.0120 －20.7851 －6.2306 －13.4209 －7.891
P值 <0.05 <0.05 <0.05 <0.05 <0.05
表3 94例胆囊结石致急性胰腺炎患者不同手术时间两组患者镇痛药使用率及完全切除率比较[例(%)]
组别 例数 镇痛药物使用率 完全切除率 中转开腹率
早期组 52 2(3.8) 51(98.1) 1(1.9)
延期组 42 8(19.0) 29(69.1) 7(16.7)
t值 ? 5.6477 15.4467 6.4863
P值 ? <0.05 <0.05 <0.05
表4 94例胆囊结石致急性胰腺炎患者不同手术时间两组患者应急指标的比较(±s)
组别 例数 时间 IL－6(μg/L) IL－10(pg/ml) CRP(μg/L)
早期组 52 治疗前 49.3±4.8 51.2±4.5 19.5±3.4
治疗后 53.2±4.7ab 42.5±4.4ab 25.8±5.7ab
延期组 42 治疗前 49.1±4.2 52.80±4.7 20.7±4.6
治疗后 61.7±5.1a 34.3±5.5a 38.5±6.8a
表5 94例胆囊结石致急性胰腺炎患者不同手术时间两组并发症发生率比较[例(%)]
组别 例数 术后胆漏 切口感染 肺部感染 胰腺炎加重 总发生率
早期组 52 1 0 1 0 2(3.8)
延期组 42 2 2 3 1 8(19.0)
χ2值 ? ? ? ? ? 5.6477
P值 ? ? ? ? ? <0.05
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