胆囊结石合并MAP行LC的时机探讨  

Discussion the opportunity of LC in the gallstone combined with MAP

作　　者：张水秀 李文茂 张吉祥 廖海 ZHANG Shuixiu;LI Wenmao;ZHANG Jixiang;LIAO Hai(The seventh Affiliated Hospital of Zunyi Medical University,XingYi 562400,China;QianXiNan People's Hospital,XingYi 562400,China)

机构地区：[1]遵义医科大学,贵州遵义563000 [2]贵州省黔西南州人民医院,贵州兴义562400

出　　处：《宁夏医学杂志》2020年第6期502-505,共4页Ningxia Medical Journal

基　　金：贵州省黔西南州社会攻关计划(20113040)。

摘　　要：目的探讨胆囊结石合并急性轻型胰腺炎(MAP)不同时期行腹腔镜下胆囊切除术(LC)治疗的临床疗效和相关成本,为医患双方共同选择最佳LC时机提供理论支持。方法将经B超、CT或MRCP检查确诊的胆囊结石合并MAP并符合入组标准的120例患者随机分为实验组和对照组,每组60例。实验组患者入院后48 h内行LC治疗;对照组患者入院后给予保守治疗,待MAP治愈出院后2~4周内返院行LC治疗。2组患者均在LC术中联合B超探查以排除胆总管结石,并对2组统计指标进行分析。结果实验组患者总住院时间、治疗费用以及胰腺炎复发率均低于对照组,差异有统计学意义(P<0.05);2组术后住院时间、并发症(除外胆道损伤)、胆道损伤、手术时间、术中出血及中转开腹对比差异无统计学意义(P>0.05)。结论胆囊结石合并MAP早期行LC合理可行,且早期手术能显著缩短总住院时间、减少治疗费用、降低胰腺炎复发率。Objective To explore the clinical effect and related cost of laparoscopic cholecystectomy(LC)in the different stages of gallstone combined with acute light pancreatitis(MAP),so as to provide theoretical support for doctors and patients to jointly choose the best LC opportunity.Methods 120 cases of gallstones with MAP diagnosed by B-ultrasound,CT or MRCP were randomly divided into the experimental group and the control group,with 60 cases in each group.The patients in the experimental group received LC treatment within 48 hours after admission.The patients in the control group were given conservative treatment after admission,and returned to hospital for LC treatment within 2~4 weeks after discharge when their conditions were improved.The patients in both groups were detected with LC combined with B-ultrasound to eliminate choledocholithiasis.Two groups of statistical indicators were analyzed.Results The total hospitalization time,treatment cost and recurrence rate of pancreatitis in the experimental group were lower than those of the control group,the difference was statistically significant(P<0.05).There was no statistically significant differenc in postoperative hospitalization time,complications(excluding biliary tract injury),biliary tract injury,operation time,intraoperative bleeding and laparotomy between the two groups(P>0.05).Conclusion LC is reasonable and feasible in early stage of cholecystolithiasis combined with MAP,and early operation can significantly shorten the total hospitalization time,reduce the cost of treatment and reduce the recurrence rate of pancreatitis.

关 键 词：胆囊结石 急性轻型胰腺炎 腹腔镜下胆囊切除术 术中B超探查 最佳时机 

分 类 号：R657[医药卫生—外科学]