非梗阻型MAGP腹腔镜胆囊切除手术时机及糖类抗原19-9变化意义  

Significance of optimal timing of laparoscopic cholecystectomy and variations in carbohydrate antigen 19-9 level in patients with non-obstructive mild acute gallstone pancreatitis

作　　者：崔巍 王旭 刘成栋[1] 龚义军 余亮 Cui Wei;Wang Xu;Liu Chengdong;Gong Yijun;Yu Liang(Department of General Surgery,the People’s Hospital of Xuancheng City,Xuancheng 242000,China)

机构地区：[1]安徽省宣城市人民医院普外科,宣城242000

出　　处：《新医学》2020年第6期428-432,共5页Journal of New Medicine

基　　金：安徽省重点研究与开发计划项目(201904a07020021);宣城市科技计划项目(201814)。

摘　　要：目的评估非梗阻型轻度急性胆石性胰腺炎(MAGP)腹腔镜胆囊切除术合理的手术时机及血清糖类抗原19-9水平变化在疾病发展过程中的意义。方法回顾性分析接受早期腹腔镜胆囊切除术治疗的181例非梗阻型MAGP患者的临床资料。按血清淀粉酶及糖类抗原19-9是否阳性将其分为3组(淀粉酶阳性定义为正常值上限的3倍或以上,糖类抗原19-9阳性为超过正常值上限),研究组1为淀粉酶阳性+糖类抗原19-9阴性(28例),研究组2为淀粉酶阳性+糖类抗原19-9阳性(21例),对照组为淀粉酶阴性+糖类抗原19-9阴性(132例)。比较各组手术相关指标及手术前后淀粉酶和糖类抗原19-9变化情况。结果3组患者在肛门排气时间、中转开腹率及并发症发生率方面比较差异均无统计学意义(P均>0.05)。术中所见,研究组2患者胆囊、胆囊三角及胆囊周围炎症的严重程度重于其他2组患者。研究组2在手术时间、住院时间、术中出血量方面劣于研究组1和对照组(P均<0.05)。淀粉酶阳性或糖类抗原19-9阳性患者腹腔镜胆囊切除术后血清淀粉酶或糖类抗原19-9水平均较术前低(P均<0.05)。结论非梗阻型MAGP患者早期行腹腔镜胆囊切除术是安全、有效的;对于同时伴糖类抗原19-9升高者,需警惕炎症的严重性及手术难度,避免并发症的发生。Objective To evaluate the significance of optimal timing of laparoscopic cholecystectomy and variations in the serum carbohydrate antigen 19-9(CA19-9)level during the progression of non-obstructive mild acute gallstone pancreatitis(MAGP).Methods Clinical data of 181 non-obstructive MAGP patients undergoing early laparoscopic cholecystectomy were retrospectively analyzed.All patients were divided into three groups:study group 1(amylase(+)+CA19-9(-),28 cases),study group 2(amylase(+)+CA19-9(+),21 cases),and control group(amylase(-)+CA19-9(-),132 cases).Amylase(+)is defined as more than 3 times of the upper limit of normal value and CA19-9(+)is defined as exceeding the upper limit of normal value.Surgery-related parameters and the changes in the amylase and CA19-9 levels before and after surgery were statistically compared among three groups.Results There was no significant difference in the flatus time,rate of conversion to open cholecystectomy and incidence rate of postoperative complications among three groups(all P>0.05).Intraoperatively,the severity of gallbladder,the triangle of Calot and perigallbladder inflammation in the study group 2 was higher compared with those in the other two groups.The operation time,length of hospital stay and intraoperative blood loss in the study group 2 were significantly worse than those in the study group 1 and control group(all P<0.05).Postoperative serum levels of amylase and CA19-9 in patients with amylase(+)or CA19-9(+)were significantly lower than preoperative levels(both P<0.05).Conclusions Early laparoscopic cholecystectomy is safe and effective for patients with non-obstructive MAGP.Nevertheless,for those complicated with elevated CA19-9 levels,extensive cautions should be taken for the severity of inflammation and surgical difficulty to avert the incidence of postoperative complications.

关 键 词：手术时机 腹腔镜胆囊切除术 非梗阻型 轻度急性胆石性胰腺炎 淀粉酶 糖类抗原19-9 

分 类 号：R657.4[医药卫生—外科学]