两镜治疗急性胆源性胰腺炎的体会  

The Evaluation of Treatment of AGP by Using the Abdominoscope and Daodenoscope

作　　者：冯志[1] 陈惠根[1] 

机构地区：[1]南昌市第二医院普外科,江西南昌330003

出　　处：《实用临床医学（江西）》2003年第6期16-18,共3页Practical Clinical Medicine

摘　　要：目的 :探讨急性胰腺炎 (acutegallstonepancreatitis ,AGP)腹腔镜及十二指肠镜治疗的可行性 ,安全性和时机性。方法 :运用腹腔镜及十二指肠镜对 348例急性胆源性胰腺炎首先行十二指肠镜下乳头括约肌切开取石 (EST) ,同时置入鼻胆管引流 (ENBD) ;合并胆囊结石者实行腹腔镜胆囊切除术 (LC) ;同时进行胰腺包膜切开、坏死组织清除及小网膜囊和大腹腔放置大口径胶管引流术。结果 :本组 2 6 6例均行EST +ENBD后 72h内行LC术及腹腔镜下胰腺包膜切开、小网膜囊和大腹腔冲洗置大口径胶管引流术。取得良好效果 ,无 1例死亡。全部痊愈出院。AGP早期腹腔粘连较轻 ,腹腔炎性液体未包裹 ,该手术创伤小、腹腔干扰少、快捷、有效 ,安全及有利于术后恢复。AGP的中期行EST +ENBD对治疗胰腺炎是有效的。AGP后期 ,在已行EST +ENBD治疗后 ,可在彩超引导下LC术及扩创引流术。结论 :AGP的两镜治疗 ,充分的体现了微创手术的可行性、安全性 ,只要掌握好手术时机性 ,是目前比较理想的治疗手段。objectives:To probing into the safty,opportunity and the possibility of applying the Abdominoscope and duodenoswpe in the treatment of AGP.Methods:Using the slightly traumatic surgical technique to treat 348 cases of AGP admitted in our hospital from 1998.5 to 2003.5.The first step was to operate EST plus ENBD.If the patient also has cholecystolithiasis,we can operate LC,pancreatotomy,necrotic tissue clearing up and place big sized rubber tube in the lesser omental bursa and the the big abdominal cavity for drainage.Results:of all treated patients, 266 cases who were first operated EST+ENBD,then(72 hours later)LC,pancreatotomy and drainage were all discharged and the effect was good and no one died.At the earlier stage of AGP,the adhesion of abdominal cavity was not so serious and no inflammatory effusion encapsulation,this was benefit for the development of slightly traumatic surgical technique,this operation had little trauma,little inferference of abdominal cavity and was speedy,safe,effective and good for the recovery after operation,at the middle stage,treating pancreatitis by operating EST+ENBD was effective.but the tissue had hyperemia and edema,the adhesion was serious,and easy to bleeding and difficult to lay bare.Conclusion:The treatment for AGP by abdominal and Duodenosape. enbodies the safety and possibility of applying this kind of operation. It's a relatively ideal freating method for AGP if we master the opportunity of the operation.

关 键 词：十二指肠镜和腹腔镜 微创 急性胆源性胰腺炎 治疗方法 

分 类 号：R657.51[医药卫生—外科学]