|本期目录/Table of Contents|

[1]刘进衡,王妍亭,肖宏,等.腹腔镜术中十二指肠镜留置鼻胆管引流早期治疗急性胆源性胰腺炎的疗效分析[J].医学研究与战创伤救治(原医学研究生学报),2020,22(2):143-146.[doi:10.3969/j.issn.1672-271X.2020.02.007]
　LIU Jin heng,WANG Yan ting,XIAO Hong,et al.Effect analysis of early treatment of acute biliary pancreatitis with duodenal endoscopic drainage during laparoscopy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(2):143-146.[doi:10.3969/j.issn.1672-271X.2020.02.007]
点击复制

腹腔镜术中十二指肠镜留置鼻胆管引流早期治疗急性胆源性胰腺炎的疗效分析()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第22卷
期数:
2020年2期
页码:
143-146
栏目:
临床研究
出版日期:
2020-03-11

文章信息/Info

Title:
Effect analysis of early treatment of acute biliary pancreatitis with duodenal endoscopic drainage during laparoscopy
作者:
刘进衡; 王妍亭; 肖宏; 陈安平; 王安琪
作者单位：610015 成都，成都市第二人民医院肝胆胰外科（刘进衡、王妍亭、肖宏、陈安平、王安琪）
Author(s):
LIU Jinheng;  WANG Yanting;  XIAO Hong;  CHEN Anping;  WANG Anqi
(Department of Hepatobiliary and Pancreatic Surgery, Chengdu Second People’s Hospital, Chengdu 610015, Sichuan, China)
关键词:
腹腔镜; 鼻胆管引流; 胆源性胰腺炎; 早期手术
Keywords:
laparoscope; nasobiliary drainage; biliary pancreatitis; early surgery
分类号:
R657.5
DOI:
10.3969/j.issn.1672-271X.2020.02.007
文献标志码:
A
摘要:
目的探讨腹腔镜术中联合十二指肠镜留置鼻胆管引流早期治疗急性胆源性胰腺炎的疗效及可行性。方法回顾性分析2015年6月至2018年8月成都市第二人民医院入院诊断为急性胆源性胰腺炎、胆总管结石合并胆囊结石62例患者的临床资料,根据手术是否在48 h内进行分为早期组（48 h内手术）和晚期组（48 h后手术），每组各31例。比较2组患者手术时间，术后肠道功能恢复时间、鼻胆管拔除时间、腹腔引流管拔除时间，并发症发生情况，总住院时间,住院总费用，术后白细胞、血淀粉酶及总胆红素。结果2组术后无胰腺炎复发。早期组与晚期组在肠道功能恢复时间[1(1,1) d vs 1(1,1) d]、术后第1天血淀粉酶[241(189,326) U/L vs 117(95,127) U/L]、总住院时间[13(11,14) d vs 18(16,19) d]和住院总费用[(2.55±0.15)万元vs (3.09±0.16)万元]比较差异有统计学意义（P＜0.05）。2组手术时间、鼻胆管拔除时间、腹腔引流管拔除时间、术后第1天白细胞、术后第1天总胆红素以及并发症发生率比较，差异无统计学意义（P＞0.05）。结论对于因胆总管结石导致的胆源性胰腺炎，尽早行腹腔镜术中联合十二指肠镜留置鼻胆管引流在围手术期多方面更能让患者获益。
Abstract:
ObjectiveEfficacy and feasibility of combined laparoscopic and duodenal endoscopic nasobiliary drainage in the early treatment of acute biliary pancreatitis.MethodsPatients diagnosed with acute biliary pancreatitis, choledocholithiasis and cholecystolithiasis from June 2015 to August 2018 were selected. They were divided into early operation group (n=31) and late operation group (n=31). The operation time, postoperative intestinal function recovery time, nasobile duct removal time, abdominal drainage tube removal time, complications, total hospitalization time, cost of hospitalization, postoperative white blood cells, blood amylase and total bilirubin were compared between two groups.ResultsThere was no recurrence of pancreatitis in both groups. There were statistically significant differences in the postoperative intestinal function recovery time[1(1,1) d vs 1(1,1) d], blood amylase on the first day postoperative[241(189,326) U/L vs 117(95,127) U/L], total hospitalization time[13(11,14) d vs 18(16,19) d] and total cost of hospitalization[(2.55±0.15) ten thousand yuan vs (3.09±0.16) ten thousand yuan] between two groups (P＜0.05).There were no statistically significant differences in operation time, time of removal of nasal bile duct, time of removal of abdominal drainage tube, white blood cells and total bilirubin on the first day postoperative (P>0.05). There was no statistically significant difference in complications between the two groups (P>0.05).ConclusionIn the treatment of biliary pancreatitis, early laparoscopic combined with duodenoscopic indwalling of the nasal bile duct drainage can benefit patients in many ways during the perioperative period.

参考文献/References:

[1]中国中西医结合学会普通外科专业委员会.重症急性胰腺炎中西医结合诊治指南(2014年,天津)[J].临床肝胆病杂志,2015,31(3):327331.
[2]包文中,孟翔凌,李良,等.胆囊结石合并急性胰腺炎患者早期腹腔镜胆囊切除术的临床疗效[J].中华肝胆外科杂志,2014,20(2):8991.
[3]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华外科杂志,2015,53(1):5053.
[4]陈安平,周华波,高原,等.同期三镜+气囊鼻胆管引流在胆囊结石合并细径胆总管结石治疗中的应用[J].肝胆胰外科杂志,2017,29(4):293296,300.
[5]李百强,李刚,叶博,等.急性胰腺炎不同时期并发急性无结石性胆囊炎超声特点分析[J].医学研究生学报,2017,30(1):6165.
[6]急性胰腺炎协作组.中国6 223例急性胰腺炎病因及病死率分析[J].胰腺病学,2006,6(6):321325.
[7]中国医师协会胰腺病学专业委员会.中国急性胰腺炎多学科诊治(MDT)共识意见(草案)[J].中华医学杂志,2015,95(38):31033109.
[8]Lee HS, Chung MJ, Park JY, et al. Urgent endoscopic retrograde cholangiopancreatography is not superior to early ERCP in acute biliary pancreatitis with biliary obstruction without cholangitis[J]. PLoS One, 2018, 13(2):e0190835. doi: 10.1371/journal.pone.0190835.
[9]王华,汪涛,汤礼军.内镜治疗高龄胆源性胰腺炎的临床疗效分析[J].东南国防医药,2014,16(5):522523.
[10]麻树人,邵晓冬,张宁,等.治疗性ERCP在胆胰疾病中的应用价值[J].中华消化内镜杂志,2006,23(1):3134.
[11]胡成彪,蒯秀梅,吴建斌.胆源性胰腺炎手术时机探讨(附57例报告)[J].东南国防医药,2005,7(2):121122.
[12]Chantarojanasiri T, Isayama H, Nakai Y, et al. Groove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology[J]. Gut Liver,2018,12(2):208213.
[13]张奇, 孙备. 梗阻型胆源性胰腺炎内镜治疗时机的选择[J]. 中国普通外科杂志, 2008, 17(3):203206.
[14]Schepers NJ, Besselink MG, van Santvoort HC, et al. Early management of acute pancreatitis[J]. Best Pract Res Clin Gastroenterol, 2013, 27(5):727743.
[15]Kamboj AK, Pidlaoan V, Shakhatreh MH, et al. A comparison of endoscopic and nonendoscopic biliary intervention outcomes in patients with prior bariatric surgery[J]. Endosc Int Open,2018,6(1):E11E28.
[16]中国加速康复外科专家组. 中国加速康复外科围手术期管理专家共识(2016)[J]. 中华外科杂志, 2016, 54(6):413418.
[17]高振华, 钱宏亮, 吕鹏翔,等. 保留Oddi括约肌功能的三镜联合治疗胆囊结石合并胆总管结石108例临床研究[J]. 影像研究与医学应用, 2017, 1(8):1113.

相似文献/References:

[1]嵇武综述,李宁,黎介寿审校.达芬奇手术机器人的应用进展[J].医学研究与战创伤救治(原医学研究生学报),2010,12(05):427.
[2]姚 宁,姜朝晖,方晓明,等.腹腔镜胆囊切除术在肝硬化患者中的应用体会[J].医学研究与战创伤救治(原医学研究生学报),2010,12(02):115.
　YAO Ning,JIANG Zhao-hui,FANG Xiao-ming,et al.Experience of laparoscopic cholecystectomy in patients with hepatic cirrhosis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2010,12(2):115.
[3]吴国华.腹腔镜手术在盆腔粘连治疗与预防中的应用[J].医学研究与战创伤救治(原医学研究生学报),2009,11(01):54.
[4]罗金玉,李 颖,张晓敏.专科护士在腹腔镜手术配合及器械保养的体会[J].医学研究与战创伤救治(原医学研究生学报),2009,11(02):168.
[5]邓 欢,赵丽君,吴金玲,等.加速康复外科护理在腹腔镜胃癌根治术患者中的应用[J].医学研究与战创伤救治(原医学研究生学报),2014,16(02):199.[doi:10.3969/j.issn.1672-271X.2014.02.029]
[6]吴超英,李 咏,赵丹梅,等.开腹与腹腔镜多发性子宫肌瘤剔除术临床疗效分析[J].医学研究与战创伤救治(原医学研究生学报),2014,16(03):278.[doi:10.3969/j.issn.1672-271X.2014.03.017]
　WU Chao-ying,LI Yong,ZHAO Dan-mei,et al.Analysis of clinical effect of open and laparoscopic multiple uterine myomectomy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2014,16(2):278.[doi:10.3969/j.issn.1672-271X.2014.03.017]
[7]李坤,赵丽君,韩晓鹏,等.损伤控制外科及加速康复外科理念在腹腔镜胃癌根治术中的应用[J].医学研究与战创伤救治(原医学研究生学报),2014,16(05):460.[doi:10.3969/j.issn.1672-271X.2014.05.004]
　LI Kun,ZHAO Li-jun,HAN Xiao-peng,et al.Application of damage control surgery and fast tract surgery in patients underwent laparoscopic radical gastrectomy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2014,16(2):460.[doi:10.3969/j.issn.1672-271X.2014.05.004]
[8]邓云,张春华,丁惠.垂体后叶素在腹腔镜下卵巢囊肿剥除术中的应用研究[J].医学研究与战创伤救治(原医学研究生学报),2014,16(05):493.[doi:10.3969/j.issn.1672-271X.2014.05.015]
　DENG Yun,ZHANG Chun-hua,DING Hui..Clinical analysis of vasopressin injection technique in laparoscopic ovarian cystectomy[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2014,16(2):493.[doi:10.3969/j.issn.1672-271X.2014.05.015]
[9]赵丽君,张彩霞,吴海霞,等.肠内营养在腹腔镜胃癌根治术后早期应用的护理体会[J].医学研究与战创伤救治(原医学研究生学报),2015,17(05):539.[doi:10.3969/j.issn.1672-271X.2015.05.030]
[10]李 坤,赵丽君,曹廷宝,等.腹腔镜姑息性胃切除术在晚期胃癌患者中的应用[J].医学研究与战创伤救治(原医学研究生学报),2015,17(06):636.[doi:10.3969/j.issn.1672-271X.2015.06.023]

备注/Memo

备注/Memo:
基金项目：四川省卫生和计划生育委员会科研课题（17PJ119）
更新日期/Last Update: 2020-03-11