临床肝胆病杂志
臨床肝膽病雜誌
림상간담병잡지
CHINESE JOURNAL OF CLINICAL HEPATOLOGY
2015年
5期
687-690
,共4页
胰腺炎%胆汁淤积%胆管炎%腹腔镜检查%引流术
胰腺炎%膽汁淤積%膽管炎%腹腔鏡檢查%引流術
이선염%담즙어적%담관염%복강경검사%인류술
pancreatitis%cholestasis%cholangitis%laparoscopy%drainage
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（ER-CP）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。
目的：探討腹腔鏡膽總管探查內置管引流術治療急性膽源性胰腺炎的臨床療效。方法迴顧性分析2012年1月－2014年5月收治的90例急性膽源性胰腺炎患者，其中腹腔鏡膽總管探查內置管引流術（腹腔鏡組）42例，經內鏡逆行胰膽管造影（ER-CP）聯閤十二指腸乳頭括約肌切開術（EST）（ERCP 組）48例，比較兩組患者手術情況、術前及術後的白細胞（WBC）、TBil、ALT、C －反應蛋白（CRP）水平的變化及隨訪情況。計量資料組間比較用 t 檢驗，計數資料組間比較採用χ2檢驗。結果兩組患者的手術時間、術中齣血量、住院費用及手術相關併髮癥差異均無統計學意義（P 值均＞0．05）。腹腔鏡組及 ERCP 組術後第1、3、7 d 血清WBC、TBil、ALT 及 CRP 水平較術前均有所下降，但兩組均隻有術後第3、7 d 與術前比較差異有統計學意義（P 值均＜0．05）。腹腔鏡組術後第3 d 血清 WBC 及 CRP 水平明顯低于 ERCP 組，差異有統計學意義（P 值均＜0．05）；兩組患者間其他同一時間點術後各指標的差異均無統計學意義（P 值均＞0．05）。隨訪6箇月，ERCP 組反流性膽管炎髮生率為6．25％（3／48），腹腔鏡組無併髮癥髮生（χ2＝2．716，P ＝0．099）。結論腹腔鏡膽總管探查內置管引流術治療膽源性胰腺炎是安全可行的，併可以保留 Oddi 括約肌功能。
목적：탐토복강경담총관탐사내치관인류술치료급성담원성이선염적림상료효。방법회고성분석2012년1월－2014년5월수치적90례급성담원성이선염환자，기중복강경담총관탐사내치관인류술（복강경조）42례，경내경역행이담관조영（ER-CP）연합십이지장유두괄약기절개술（EST）（ERCP 조）48례，비교량조환자수술정황、술전급술후적백세포（WBC）、TBil、ALT、C －반응단백（CRP）수평적변화급수방정황。계량자료조간비교용 t 검험，계수자료조간비교채용χ2검험。결과량조환자적수술시간、술중출혈량、주원비용급수술상관병발증차이균무통계학의의（P 치균＞0．05）。복강경조급 ERCP 조술후제1、3、7 d 혈청WBC、TBil、ALT 급 CRP 수평교술전균유소하강，단량조균지유술후제3、7 d 여술전비교차이유통계학의의（P 치균＜0．05）。복강경조술후제3 d 혈청 WBC 급 CRP 수평명현저우 ERCP 조，차이유통계학의의（P 치균＜0．05）；량조환자간기타동일시간점술후각지표적차이균무통계학의의（P 치균＞0．05）。수방6개월，ERCP 조반류성담관염발생솔위6．25％（3／48），복강경조무병발증발생（χ2＝2．716，P ＝0．099）。결론복강경담총관탐사내치관인류술치료담원성이선염시안전가행적，병가이보류 Oddi 괄약기공능。
Objective To evaluate the clinical effect of laparoscopic common bile duct exploration combined with endobiliary drainage in the treatment of acute biliary pancreatitis.Methods A 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 ex-ploration combined with endobiliary drainage (laparoscopic group),and 48 patients underwent endoscopic retrograde cholangiopancreatogra-phy (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.Results There 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 re-duced 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).Conclusion Laparoscopic 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.
