Search

膽囊結石嵌頓的腹腔鏡手術57例體會

Endoscopic Therapy of Biliary Obstructive Acute Pancreatitis (Report of 30 Cases)

目的　 觀察內鏡治療急性膽源性胰腺炎（ABP）的療效及其并發癥。方法　 30例ABP患者在抗炎、抑酶等綜合治療基礎上，經內鏡（1～3 d 內）逆行胰膽管造影（ERCP）及經內鏡十二指腸乳頭括約肌切開（EST）或鼻膽管引流（ENBD）等治療。結果　內鏡治療后22 例（73.3%）輕癥急性膽源性胰腺炎（MABP）患者3～5 d 體溫恢復正常； 8例（26.7%）　重癥急性膽源性胰腺炎（SABP）患者3～8 d 腹部體征好轉，血常規、淀粉酶及血生化1~2周內基本恢復，平均住院18.7 d，3例死亡（10.0%）。內鏡治療過程中5例出現十二指腸乳頭括約肌切口少量出血，經簡單治療止血，未再出現其他并發癥。與同期開腹手術治療相比較，癥狀體征緩解、血常規、淀粉酶、血生化恢復正常及住院的時間更短，死亡率無明顯差異。結論　ABP早期ERCP 及內鏡治療安全有效。

Control Study of Treatments for Severe Acute Pancreatitis During Different Periods

ObjectiveTo evaluate the therapic efficacy for severe acute pancreatitis (SAP) during different periods. MethodsAccording to internalized standard, 234 patients with SAP admitted to this hospital from January 1986 to October 2009 were included, which were divided into two stages based on the time of admitting to this hospital. The first stage named prior operation group was from January 1986 to August 1998 (n=117), the second stage named individual treatment group was from September 1998 to October 2009 (n=117). There was comparability in demography and clinic between two groups. The prior operation group primarily underwent laparotomy and medication, and the individual treatment group underwent multiple combined therapies. These indexes were compared between two groups: hospital stay, cure rate, and mortality; the incidences of pancreatic pseudocyst, pancreatic and peripancreatic abscess, pancreatic encephalopathy, cardiac insufficiency, acute renal failure (ARF), acute respiratory distress syndrome (ARDS), and shock. The efficacies for early treatment, ascites, biliary pancreatitis, and pancreatic and peripancreatic complications were compared two groups by stratified analysis. ResultsCompared with the prior operation group, the hospital stay was shorter (Plt;0.05), cure rate was higher (Plt;0.001), and mortality was lower in the individual treatment group (Plt;0.001). During the treatments, the incidences of pancreatic pseudocyst, pancreatic and peripancreatic abscess, pancreatic encephalopathy, cardiac insufficiency, ARF, ARDS, and shock in the individual treatment group were lower than those in the prior operation group (Plt;0.05). According to the stratified analysis, the efficacies for early treatment, ascites, biliary pancreatitis, and pancreatic and peripancreatic complications in the individual treatment group were better than those in the prior operation group (Plt;0.001). ConclusionIn recent years, the change of therapeutic mode significantly improves the treatment efficacy for SAP.