胆囊切除术后急性胰腺炎患者314例的发病特点分析

目的:研究胆囊切除术后患者发生急性胰腺炎的发病特点。方法:回顾性分析2009年10月至2013年10月四川大学华西医院诊断为急性胰腺炎且既往行胆囊切除术患者的病因、病情严重程度、临床特征与转归。结果:研究共纳入314例患者,以高脂血症性胰腺炎占比最高,共110例(35%),胆源性胰腺炎和混合性胰腺炎分别为107例(32%)、96例(31%),酒精性仅7例(2%)。轻症215例,中度31例,重度68例。高脂血症性胰腺炎患者重症率(36%)、胰腺及胰周坏死率(28%)、持续性器官功能衰竭率(36%)、呼吸衰竭率(41%)、ICU转入率(26%)均显著高于胆源性组和混合组,差异具有统计学意义(P0.05)。结论:胆囊切除后的急性胰腺炎以胆源性胰腺炎和高脂血症性胰腺炎居多,其中高脂血症性胰腺炎的病情更严重。

Characteristic Analysis of 314 Cases of Patients with Acute Pancreatitis after Cholecystectomy

ABSTRACT Objective: To determine the characteristics of patients with acute pancreatitis(AP) after cholecystectomy. Methods: The etiology, severity, clinical feature of AP patients with the history of cholecystectomy in West China Hospital from October 2009 to October 2013 were retrospectively analyzed. Results: 314 patients were enrolled. The most frequent causes were hyperlipidemic pancre- atitis (110, 35%), biliary pancreatitis (107, 32%), alcoholic pancreatitis (7, 2%), and the mixed-causes pancreatitis (96, 31%). 215 cases were mild AP, 31 cases were moderately severe AP, 68 cases were severe AP. The rate of severe AP(36%), pancreatic and peripancreatic necrosis(28%), persistent organ failure(36%), respiratory failure(41%), ICU transferring(26%) in hyperlipidemic pancreatitis weree sig- nificantly higher than those of the biliary pancreatitis and the mixing-causes pancreatitis. Conclusion: Biliary pancreatits and hyperlipi- demic pancreatitis were dominantly prevalent in AP patients with history of cholecystectomy, hyperlipidemic pancreatitis was more se- vere than that of biliary pancreatitis.