急性胰腺炎患者腹腔镜胆囊切除术的时机研究

目的：探讨急性胰腺炎胆囊切除术的有效性及时机。方法：分别对患有急性胰腺炎而进行腹腔镜胆囊切除的38例患者的临床信息进行了研究。结果：首先对38例病人进行了3-15天非手术的保守治疗，当临床症状和表征基本消失，血、尿中的淀粉酶接近正常水平时，进行胆囊切除。手术时间为30分钟到90分钟（平均时间60分钟），手术中无转化和严重并发症症状发生。对这38例病人随访6到56周后无复发现象发生。结论：当临床症状和表征基本消失，血、尿中的淀粉酶接近正常水平时，急性胰腺炎胆囊切除术是有效且可行的。在中国患有急性胰腺炎的患者中，进行腹腔镜胆囊切除的占50％～70％。胆结石治疗取决于患者胰腺炎的严重性，及患者是否患有梗阻性黄疸。对于非梗阻性胰腺炎的患者，早期是否要进行明确的手术治疗尚无定论。我院患有急性胰腺炎的38例患者进行腹腔镜胆囊切除术（2004年2月到2009年4月之间）后取得了满意的效果。详情如下。

The Timing of Laparoscopic Cholecystectomy for Patients with Acute Biliary Pancreatitis

Objective： To explore the feasibility and timing of laparoscopic cholecystectomy （LC） for patients with acute biliary pancreatitis （ABP）. Methods： Clinical information of 38 patiems with ABP treated by LC were retrospectively studied. Results： The 38 patients initially received non-surgical conservative treatment for 3~15d, and then were treated by LC when the clinical symptoms and signs nearly disappeared, and urinary amylase and serum amylase levels almost returned to normal. The operating time ranged from 30min to 90min （mean 60min） without conversion and serious complications. And the 38 cases showed no recurrence during postopera- tive follow-up of 6 months to 56 months. Conclusions： The treatment of ABP by LC is feasible and effective when the patients＇ clinical symptoms and signs nearly disappear, and urinary amylase and serum amylase levels almost return to normal. Patients with ABP constitutes 50%-70% of acute pancreatitis cases in China. Treatment of gallstones depends on the severity of pancreatitis and whether the pa- tient has obstructive jaundice and cholangitis. For the treatment of non-obstructive biliary pancreatitis, it is still controversial that whether the early definitive surgery should be performed. The 38 patients with ABP treated by LC （Feb., 2004_-Apr., 2009） achieved satisfactory effect in our hospital. Details are as follows.