腹腔镜胆囊切除时机是否影响急性胆源性胰腺炎的开腹中转率  

Does the timing of laparoscopic cholecystectomy affect the conversion rate of acute biliary pancreatitis

作　　者：吴鹏飞 唐国华 邱钧 李志贵 项本宏 方寅 WU Peng-fei;TANG Guo-hua;QIU Jun(Department of General Surgery,the First People's Hospital ofWuhu,Wuhu 241000,China)

机构地区：[1]芜湖市第一人民医院,芜湖241000

出　　处：《肝胆外科杂志》2021年第4期279-283,共5页Journal of Hepatobiliary Surgery

基　　金：院内科研(2018WYY014N)。

摘　　要：目的比较和评估腹腔镜胆囊切除(LC)时机与急性胆源性胰腺炎(BP)后转换为开放手术的比率和原因之间的关系。方法收集首次出现急性BP并接受LC的患者的数据;将患者分为两组:早期LC(A组),入院时和出院前(1~3天)第一次胰腺炎发作期间接受了胆囊切除术的患者;晚期LC(B组),在首次胰腺炎发作期间接受药物治疗并在4~10周后接受手术的患者。比较性别,Ranson评分,美国麻醉学会评分和中转原因。结果A组和B组分别包括35例患者(15例男性,20例女性)和38例患者(13例男性,25例女性);平均年龄为41.6岁;在9例患者(A组有5例,B组有4例)中发现胆囊三角区域组织粘连是转换开腹手术的主要原因,但无统计学意义(P=0.072);在2例患者中有脓胸的急性炎症(A组中有2例,B组中无),2组中转开腹率在统计学上显着提高(P=0.017)。结论腹腔镜胆囊切除的时机不影响胆源性胰腺炎后开腹中转率。Objective To compare and evaluate the relationship between the rate and cause of conversion to open surgery after laparoscopic cholecystectomy(LC)and acute biliary pancreatitis(BP).Methods Data were collected from patients with acute BP who underwent LC;patients were divided into two groups:early LC(group A),and at the time of admission and before discharge(1~3 days)during the first pancreatitis episode undergoing cholecystectomy Patients who underwent surgery;advanced LC(group B),patients who received medication during the first episode of pancreatitis and underwent surgery 4~10 weeks later.Compare gender,Ranson score,American Society of Anesthesiology scores and reasons for transit.Results Group A and B included 35 patients(15 males,20 females)and 38 patients(13 males,25 females);the average age was 41.6 years;in 9 patients(5 patients in group A)There were 4 cases in group B.The adhesion of gallbladder triangle tissue was the main reason for conversion to open surgery,but it was not statistically significant(P=0.072).In 2 patients,there was acute inflammation of empyema(in group A)2 cases,none in group B,the rate of conversion to laparotomy was statistically significantly increased(P=0.017).Conclusion The timing of laparoscopic cholecystectomy does not affect the rate of laparotomy after biliary pancreatitis.

关 键 词：腹腔镜胆囊切除 急性胆源性胰腺炎 中转开腹 

分 类 号：R657.9[医药卫生—外科学]