摘要
目的 比较腹腔镜胆囊切除术联合胆总管探查取石术(LC+LCBDE)与内镜逆行胰胆管造影/乳头括约肌切开取石术联合腹腔镜胆囊切除术(LC+ERCP/EST)治疗急性胆源性胰腺炎的临床疗效.方法 回顾性分析大同市第三人民医院肝胆外科2017年1月至2021年1月收治的急性胆源性胰腺炎患者(伴胆总管结石合并胆囊结石)临床资料.共入组44例患者,其中男性23例,女性21例,年龄(60.6±11.7)岁.依据治疗方法不同,44例患者分为LC+LCBDE组(n=33)和LC+ERCP组(n=11,行LC+ERCP/EST).比较两组术前总胆红素、直接胆红素、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血淀粉酶,以及手术时间、术后住院时间、住院总费用、术后排气时间,以及术后并发症(胆漏、残余结石、发热、出血等).结果 LC+ERCP组和LC+LCBDE组术前总胆红素、直接胆红素、ALT、AST、血淀粉酶比较,差异均无统计学意义(均P＞0.05).LC+LCBDE组手术时间为[M(Q1,Q3)]110.0(96.3,147.5)min、术后住院时间为9.0(7.5,11.0)d、术后排气时间为 2.0(1.0,2.0)d,多于 LC+ERCP 组手术时间 60.0(32.0,65.0)min、术后住院时间 7.0(4.0,8.0)d、术后排气时间 1.0(1.0,1.0)d,LC+LCBDE 组住院总费用为 23 829.3(21 779.6,27 221.9)元,低于LC+ERCP组住院总费用36894.8(31 963.5,41 172.2)元,差异均有统计学意义(均P＜0.05).LC+ERCP组和LC+LCBDE组术后总胆红素、直接胆红素、ALT、AST等比较,差异均无统计学意义(均P＞0.05).两组均无胆漏、发热、出血等术后并发症发生.结论 与LC+ERCP/EST比较,LC+LCBDE治疗急性胆源性胰腺炎虽然手术时间和住院时间长,但住院总费用更少,无需分次手术,可作为急性胆源性胰腺炎的首选手术方式.
Abstract
Objective To juxtapose laparoscopic cholecystectomy combined with common bile duct exploration and stone extraction(LC+LCBDE)against endoscopic retrograde cholangiopancreatography/sphincterotomy with laparoscopic cholecystectomy(LC+ERCP/EST)in the therapeutic context of acute bili-ary pancreatitis.Methods The clinical data of patients with acute biliary pancreatitis in Department of Hepatobiliary Surgery,Datong Third People's Hospital from January 2017 to January 2021 were retrospectively analyzed.A total of 44 patients were inrolled,including 23 males and 21 females,with the age of(60.6± 11.7)years.Based on different treatment approaches,the patients were divided into the LC+LCBDE group(n=33)and the LC+ERCP group(n=11,LC+ERCP/EST).Total bilirubin,direct bilirubin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood amylase,operation time,postoperative hospitalization stays,total hospitalization cost,postoperative anal exhaust time,and postoperative complica-tions(bile leakage,fever,bleeding)were compared between the two groups.Results There were no sig-nificant differences in preoperative total bilirubin,direct bilirubin,ALT,AST,and blood amylase between LC+ERCP group and LC+LCBDE groups(all P＞0.05).In LC+LCBDE group,operation time was 110.0(96.3,147.5)min,postoperative hospitalization time was 9.0(7.5,11.0)d,postoperative exhaust time was 2.0(1.0,2.0)d,and in LC+LCBDE group,operation time was 60.0(32.0,65.0)min,postoperative hospitalization time was 7.0(4.0,8.0)d,postoperative exhaust time was 1.0(1.0,1.0)d.Comparisons with LC+LCBDE group,LC+ERCP group had shorter postoperative hospitalization stay and earlier postoperative exhaust time,the total hospitalization cost of LC+LCBDE group was 23 829.3(21 779.6,27 221.9)yuan,which was higher than 36 894.8(31 963.5,41 172.2)yuan in LC+ERCP group,and the differences were statistically significant(all P＜0.05).Comparison of postoperative total bilirubin,direct bilirubin,ALT and AST between LC+ERCP group and LC+LCBDE group,with no signif-icant difference(all P＞0.05).No postoperative complications such as bile leakage,residual stones,fever and bleeding occurred in both groups.Conclusion Compared with LC+ERCP/EST,LC+LCBDE in the treatment of acute biliary pancreatitis,although the operation time and hospital stay are longer,but the total hospitalization cost is less,there is no need for multiple operations,and it can be used as the first choice for acute biliary pancreatitis.
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