早期三镜手术联合甘露醇导泻治疗胆源性胰腺炎的临床应用研究  

The clinical efficacy of early three-endoscope surgery and catharsis therapy with mannitol for biliary pancreatitis

作　　者：范中宝[1] 沈建芬[1] 廉皓 毛屏[1] 柳青峰[1] 王键[1] FAN Zhong-bao;SHEN Jian-fen;LIAN Hao(First Department of General Surgery,the People’s Hospital of Liaoning Province,Shenyang 110001,China)

机构地区：[1]中国医科大学人民医院暨辽宁省人民医院普外一科,辽宁沈阳110001

出　　处：《腹腔镜外科杂志》2020年第12期932-937,943,共7页Journal of Laparoscopic Surgery

基　　金：辽宁省自然科学基金指导计划项目(2019-ZD-0423)。

摘　　要：目的:探讨早期应用三镜(腹腔镜、胆道镜、十二指肠镜)手术取石联合甘露醇导泻治疗胆源性胰腺炎的临床疗效。方法:回顾分析2019年1月1日至2020年3月31日收治的87例胆囊结石、胆总管结石合并胆源性胰腺炎患者的临床资料。早期采用三镜手术联合甘露醇导泻治疗的48例患者作为观察组;先行内镜逆行胰胆管造影/内镜十二指肠乳头括约肌切开术取石、鼻胆管引流术,待病情稳定3~5 d后行腹腔镜胆囊切除术的39例患者作为对照组,分析比较两组患者临床资料、相关指标及术后第1天、第2天、第3天相关化验指标,术后1周康复质量指标。结果:两组患者均治愈出院,无胆漏、腹膜炎、腹腔脓肿发生。两组患者下床活动时间、结石完全清除率及术后第1天、第2天、第3天GGT、DBIL差异无统计学意义(P>0.05)。观察组排气时间短,腹痛、腹胀缓解快,麻痹性肠梗阻、胃肠功能紊乱发生率低,中转开腹率低,住院时间短,住院费用少,WBC、C反应蛋白、淀粉酶、脂肪酶恢复更快,术后1周生活质量更高,与对照组相比差异有统计学意义(P<0.05)。结论:早期三镜手术联合甘露醇导泻治疗胆源性胰腺炎,症状恢复快,并发症少,住院时间短,住院费用低,康复质量高,临床疗效好,可作为胆源性胰腺炎治疗的优选术式。Objective:To investigate the clinical efficacy of early three-endoscope surgery(laparoscopy,choledochoscopy and duodenoscopy)combined with mannitol catharsis for the patients with biliary pancreatitis.Methods:A retrospective analysis was performed on 87 patients with cholecystolithiasis,choledocholithiasis and biliary pancreatitis from Jan.1,2019 to Mar.31,2020.48 patients treated by early three-endoscope surgery combined with mannitol catharsis were assigned to the observation group.39 patients underwent endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy lithotomy and nasobiliary drainage,then laparoscopic cholecystectomy 3 to 5 d after endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy,they were set as the control group.The baseline data,clinical and laboratory indexes on the first,second and third day after operation,and the rehabilitation quality were compared between the two groups.Results:There were no death or complications in the two groups,such as bile leakage,peritonitis and abdominal abscess.There was no statistically significant difference between the two groups in the indexes about time of ambulation,the rate of calculi removal,and the GGT,DBIL on the first,second and third day after operation(P>0.05).In the observation group,the postoperative exhaust,relief of abdominal pain and distension was faster,incidence of paralytic intestinal obstruction,gastrointestinal dysfunction and conversion to laparotomy was lower,the hospital stay was shorter,expenditure of hospitalization was less.The recovery of serum WBC,C-reactive protein,amylase and lipase was earlier,the rehabilitation quality one week after operation was better than control group(P<0.05).Conclusions:The clinical efficacy of early three-endoscope surgery combined with mannitol catharsis for biliary pancreatitis is significant.This procedure can promote the recovery of clinical syndrome,reduce the incidence of complications,hospital stay and expenditure of hospitalization,and can be regarded as optimal

关 键 词：胆源性胰腺炎 胆石 腹腔镜检查 胆道镜检查 十二指肠镜检查 甘露醇导泻 

分 类 号：R657.51[医药卫生—外科学]