十二指肠镜联合腹腔镜治疗急性胆源性胰腺炎的疗效观察  

Treatment efficacy of duodenoscopic combined with laparoscopic cholecystectomy treatment in patient with acute biliary pancreatitis

作　　者：杨维忠[1] 苏鲁[1] 段珊[1] 熊伟[1] 

机构地区：[1]海南医学院附属新华医院消化内镜科,海南海口570311

出　　处：《中国内镜杂志》2010年第7期700-703,共4页China Journal of Endoscopy

摘　　要：目的观察十二指肠镜下行胆总管取石或内支架引流后,再行腹腔镜胆囊切除治疗胆源性胰腺炎的长期疗效。方法 72例合并有胆囊结石的急性胰腺炎患者分成治疗组(40例)和对照组(32例),治疗组患者先行十二指肠镜逆行胰胆管造影(ERCP),根据胆管造影结果,采取乳头切开(EST)、胆管取石或胆管内支架引流术。患者在行十二指肠镜手术治疗病情稳定后,再行腹腔镜胆囊切除术(LC),对照组患者行内科保守治疗。结果治疗组患者行ERCP,诊断为胆总管小结石13例,胆总管末端炎症性狭窄12例,胆总管未见异常15例,12例胆总管末端炎症性狭窄患者行EST或胆管内支架引流术,另28例患者均行乳头切开。LC术36例,4例失败转手术,所有患者在出院后随访2年,治疗组患者治疗后2年内未见再发急性胰腺炎患者,对照组患者内科保守治疗后2年内有40.6%(13/32)患者再发急性胰腺炎。结论对于合并有胆囊结石的急性胆源性胰腺炎患者,通过十二指肠镜行乳头切开取石或胆管内支架引流治疗急性胰腺炎,再行腹腔镜胆囊切除术,比对照组能够有效的预防急性胰腺炎的发作。【Objective】To observe the long-term clinical result of treating biliary pancreatitis by duodenoscopic choledochlithoextration or inner frame drainage followed by laparosopic cholecystectomy.【Methods】72 case of patients with acute pancreatitis combined with gallstone were divided into treatment group （40 cases） and comparison group. The patients in treatment group were conducted endoscopic retrograde cholangiopancreatography （ERCP）,according to the result of chalangiography,endoscopic sphincterotomy,choledocholithoextraction or inner frame drainage was performed. All the patients were performed laparoscopic cholecystectomy （LC） after their condition were stable. The patients of the comparison group were adopted medical conservative treatment.【Results】The patients of the treatment group were performed ERCP. 13 cases were diagnosed as common bile duct microlith,12 cases as choledochus terminal inflammatory stenosis,15 cases couldn＇t be found any abnormality in common bile duct. 12 patients with cholechochus terminal inflammatory stenosis were performed papillosphincterotomy or inner biliary frame drainage. 28 patients of treatment group were performed endoscopic sphincterotomy. Laparoscopic cholecystectomy was performed in 40 patients,of 4 cases were changed to abdominotomy. All patients were followed up 2 year after dischargement. No acute pancreatitis recurrented in the patients of the treatment group in 2 years after treatment; while 13 patients of the comparison group suffered from acute pancreatitis again in 2 years after medical conservative treatment.【Conclusions】For the patients with acute biliary pancreatitis combined with gallstone,it can prevent the episode of acute pancreatitis that treating acute pancreatitis by duodenoscopic papillosphincterotomy and stone-extraction or inner biliary frame drainage followed by laparoscopic cholecystectomy.

关 键 词：十二指肠镜 腹腔镜 急性胆源性胰腺炎 

分 类 号：R657.51[医药卫生—外科学]