摘要
目的 研究腹腔镜胆囊切除术（LC）治疗结石性胆囊炎合并轻症急性胆源性胰腺炎（MABP）的合适手术时机，并评估其安全性和临床疗效。方法 选取本院2020年6月～2023年6月结石性胆囊炎合并MABP患者共86例，随机分为实验组和对照组，实验组患者在入院后48～72小时内行LC治疗，对照组患者待胰腺炎症状明显缓解后1～2周内接受LC治疗。比较两组的手术时间、术后住院时间、围手术期并发症（胆漏、出血、切口感染、胆管损伤等）发生率、中转剖腹率、总住院时间、总医疗费用以及胰腺炎复发率等指标。结果 两组手术均获成功，无严重并发症及死亡；两组的围手术期并发症发生率、中转剖腹率、胰腺炎复发率、手术时间均无显著差异（P＞0.05）；术后住院时间：实验组较对照组显著延长（P＜0.05）；总住院时间：实验组较对照组显著缩短（P＜0.05）；总医疗费用：实验组较对照组显著降低（P＜0.05）。结论 结石性胆囊炎合并轻症急性胆源性胰腺炎患者在入院48～72小时内行腹腔镜胆囊切除术是安全有效的，临床疗效满意。
关键词： 腹腔镜胆囊切除术；结石性胆囊炎；轻症急性胆源性胰腺炎；手术时机
Abstract
Objective To evaluate the safety and clinical efficacy of laparoscopic cholecystectomy for the treatment of calculous cholecystitis complicated with mild acute biliary pancreatitis. Methods A total of 86 patients with calculous cholecystitis combined with mild acute biliary pancreatitis were selected from our hospital from June 2020 to June 2023, and were randomly divided into experimental group and control group. Patients in the experimental group received LC treatment within 48 to 72 hours of admission, and patients in the control group received LC treatment within 1 to 2 weeks after significant relief of pancreatitis symptoms. The indexes of operation time, postoperative hospital stay, perioperative complications (bile leakage, bleeding, incision infection, bile duct injury, etc.), rate of laparotomy, total hospital stay, total medical expenses and recurrence rate of pancreatitis were compared between the two groups. Results Both groups were successfully operated without serious complications or death. There were no significant differences in perioperative complication rate, rate of laparotomy, recurrence rate of pancreatitis and operation time between the two groups (P>0.05). Postoperative hospital stay: the experimental group was significantly longer than the control group (P<0.05); Total hospital stay: the experimental group was significantly shorter than the control group (P<0.05); Total medical expenses: The experimental group was significantly lower than the control group (P<0.05). Conclusion s Laparoscopic cholecystectomy is safe and effective in patients with calculous cholecystitis complicated with mild acute biliary pancreatitis within 48-72 hours of admission, and the clinical effect is satisfactory.
Key words： Laparoscopic cholecystectomy; Calculous cholecystitis; Mild acute biliary pancreatitis; Timing of surgery
参考文献 References
[1] Boxhoorn L, Voermans RP, Bouwense SA, et al. Acute pancreatitis[J]. Lancet, 2020, 396(10252):726-734.
[2] 宫子建,王薪宇,高洪洋.腹腔镜胆囊切除术后医院感染危险因素分析[J].中国实验诊断学,2020,24(03):473-474.
[3] 齐丽霞.胆囊结石行腹腔镜下胆囊切除的护理方法与效果研究[J].中国医药指南,2019,17(33):331-332.
[4] 高盼盼,李静.急性胰腺炎临床特点的研究进展[J].锦州医科大学学报,2018,39(06):97-101.
[5] Zhang WJ,Xu GF,Huang Q,et al.Treatment of gallbladder stone with common bile duct stones in the laparoscopicera[J]. BMC Surg,2015,15(1):1-6.
[6] 林健群,洪建文,杨熙.胆源性胰腺炎240例治疗体会[J].中国现代普通外科进展,2014,17(8):657-659.
[7] Nguyen GC, Boudreau H, Jagannath SB. Hospital volume as a predictor for undergoing cholecystectomy after admission for acute gallstone pancreatitis[J].Pancreas, 2010,39(1):e42-e47.
[8] Bakker OJ, van Santvoort HC, Hagenaars JC, et al. Timing of cholecystectomy after mild pancreatitis[J].Br J Surg, 2011,98(10):1446-1454.
[9] 吕坤,陈翔.复发性胆源性胰腺炎的临床特点及诱发因素分析[J].临床肝胆病杂志,2016,32(01):127-130.
[10] Serena Stigliano, Flaminia Belisario, Matteo Piciucchi, et al. Recurrent biliary acute pancreatitis is frequent in a real-world setting[J].Digestive and Liver Disease,2018,50(3):277-282.
[11] Garg SK,Campbell JP,Anugwom C, et al. Incidence and predictors of readmissions in acute pancreatitis:a Nationwide analysis[J].Pancreas,2018,47(1):46-54.
[12] 中华医学会外科学分会胰腺外科学组.中国急性胰腺炎诊治指南（2021）[J].中国实用外科杂志,2021,41(7):739-746.
[13] Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis[J].World J Emerg Surg,2019,14:27.
[14] Dubina ED, de Virgilio C, Simms ER, et al. Association of early vs delayed cholecystectomy for mild gallstone pancreatitis with perioperative outcomes[J]. JAMA Surg, 2018, 153(11):1057-1059.
[15] 肖俊,陈海川,余海波,等.胆囊结石伴急性胆源性胰腺炎的微创治疗[J].中国微创外科杂志,2014,14(5):399-401.
[16] 陈胜,吴卫泽,李能平.轻症胆源性胰腺炎腹腔镜胆囊切除手术时机的探讨[J].中华胰腺病杂志,2016,16(5):326-330.
[17] Alper B, Mehmet T, Ersin G, et al. Early versus delayedlaparoscopic cholecystectomy for acute cholecystitis: a prospective,randomized study[J]. Int Surg, 2014, 99(1):56 -61.
[18] 周妍,闫军. 轻症急性胆源性胰腺炎行腹腔镜胆囊切除术的最佳手术时机研究[J].武警医学,2019,30(6):484-487.