Effect of early laparoscopic surgery combined with endoscopic nassl biliary (pancreatic) drainage in the treatment of severe acute pancreatitis patients
LIU Ning
The First Department of General Surgery, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Hubei Province, Xiaogan 432000, China
Abstract：Objective To investigate the effect of early laparoscopic surgery combined with endoscopic naso biliary (pancreatic) drainage in the treatment of severe acute pancreatitis and the postoperative follow-up results of mid term and long term. Methods Seventy-four patients with severe acute pancreatitis (SAP) from February 2011 to May 2014 in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology were retrospectively analyzed and divided into experimental group and control group according to different surgical procedures, with 37 cases in each group. The control group received laparoscopic surgery, and the experimental group received laparoscopic surgery combined with endoscopic nasal biliary (pancreatic) drainage. The surgical results, postoperative complication rate, the changes of preoperative and postoperative 32 d of serum amylase and inflammatory factor [tumor necrosis factor (TNF) -α, interleukin (IL)-6, C reactive protein (CRP), IL-8] of the two groups were compared. Followed-up for three years, the mortality rates of both groups were counted. Results ①Serum amylase: there was no significant difference in serum amylase level between the two groups (P ＞ 0.05), the levels of serum amylase in the two groups were significantly lower than that before surgery, the experimental group was significantly lower than the control group, and the difference was highly statistically significant (P ＜ 0.01). ②Operation effect: the total effective rate in the experimental group (89.19%) was significantly higher than that in the control group (67.57%), the difference was statistically significant (P ＜ 0.05). ③Postoperative complications: the incidence of postoperative complication rate in the experimental group (10.81%) was significantly lower than that in the control group (29.73%), the difference was statistically significant (P ＜ 0.05). ④Serum inflammatory factors: the levels of serum inflammatory factors TNF-α, IL-6, CRP and IL-8 were significantly lower than those before operation (P ＜ 0.01). The levels of TNF-α, IL-6, CRP and IL-8 in the experimental group were significantly lower than those in the control group, the differences were highly statistically significant (P ＜ 0.01). ⑤Postoperative fatality rate: there was no statistically significant difference between the two groups in 1 year after surgery (P ＞ 0.05). The mortality rate of the experimental group (10.81%) was lower than that of the control group (29.73%), the difference was statistically significant (P ＜ 0.05). Conclusion Early laparoscopic surgery combined with endoscopic nasal biliary (pancreatic) drainage for the treatment of SAP can significantly reduce serum amylase, the levels of inflammatory factors TNF-α, IL-6, CRP and IL-8, and can effectively reduce the incidence of postoperative complication rate and fatality rate and further improve the operation effect.
刘宁. 早期腹腔镜手术联合内镜鼻胆（胰）引流治疗重症急性胰腺炎患者的效果[J]. 中国医药导报, 2018, 15(4): 77-81.
LIU Ning. Effect of early laparoscopic surgery combined with endoscopic nassl biliary (pancreatic) drainage in the treatment of severe acute pancreatitis patients. 中国医药导报, 2018, 15(4): 77-81.
[1] Babu RY，Gupta R，Kang M，et al. Predictors of surgery in patients with severe acute pancreatitis managed by the step-up approach [J]. Ann Surg，2013，257（4）：737-750.
[2] 肖红雯.不同营养支持对老年重症急性胰腺炎患者的疗效及对炎症因子和肠道黏膜屏障功能的影响[J].中国老年学杂志，2017，37（15）：3806-3808.
[3] 邱庆文.重症急性胰腺炎患者腹腔镜手术围术期胃肠激素及机体应激状态变化观察[J].中南医学科学杂志，2015， 43（6）：675-678.
[4] 刘宁江，李荣，李称才，等.腹腔镜手术治疗急性重症胰腺炎腹内高压疗效分析[J].国际医药卫生导报，2013，19（4）：476-479.
[5] 刘继东，阎玉矿，廖红霞，等.腹腔镜早期手术联合清胰汤治疗重症急性胰腺炎临床分析[J].山西医科大学学报，2014，45（8）：764-767.
[6] Zhao XL，Zhu SF，Xue GJ，et al. Early oral refeeding based on hunger in moderate and severe acute pancreatitis：a prospective controlled，randomized clinical trial [J]. Nutrition，2015，31（1）：171-175.
[7] 刘建辉，李全福，刘爱梅，等.早期腹腔镜手术联合内镜鼻胆（胰）引流治疗重症急性胰腺炎的临床效果[J].中国全科医学，2009，12（4）：332-333.
[8] 中华医学会外科学会胰腺外科学组.重症急性胰腺炎诊治草案[J].中华肝胆外科杂志，2002，8（2）：110-111.
[9] 姚继勇.腹腔镜手术治疗重症急性胰腺炎30例临床分析[J].吉林医学，2014，35（12）：2577-2578.
[10] 李鑫，韩奕，杜施霖.大黄治疗重症急性胰腺炎的机制与作用研究进展[J].中国中西医结合急救杂志，2014， 21（2）：141-143.
[11] 张茂良，赵齐羽，邓壮，等.老年重症急性胰腺炎早期治疗中超声引导下经皮穿刺置管灌洗引流对临床疗效及实验室指标的影响[J].中国老年学杂志，2017，37（14）：3534-3536.
[12] Wang G，Wen J，Xu L，et al. Effect of enteral nutrition and ecoimmunonutrition on bacterial translocation and cytokine production in patients with severe acute pancreatitis [J]. J Surg Res，2013，183（2）：592-597.
[13] 张小明，马平安，孙建伟，等.清胰承气汤治疗重症急性胰腺炎患者的临床研究[J].中国中西医结合杂志，2014， 34（1）：31-34.
[14] 夏亮，陈军贤，谢齐贵，等.中药联合早期肠内营养在治疗重症急性胰腺炎中的作用[J].中国中西医结合急救杂志，2014，21（1）：14-17.
[15] 许益平，何卓亚，杨国才，等.早期肠内营养对重症急性胰腺炎肠源性感染影响的临床研究[J].中国现代医生，2014，52（2）：16-18.
[16] Sun JK，Mu XW，Li WQ，et al. Effects of early enteral nutrition on immune function of severe acute pancreatitis patients [J]. World J Gastroenterol，2013，19（6）：917.
[17] 杨春雷.腹腔镜下手术治疗重症急性胰腺炎的手术时机和疗效探讨[J].当代医学，2015，21（4）：94-95.
[18] 刘荣，张煊.腹腔镜手术治疗重症急性胰腺炎策略及要点[J].中国实用外科杂志，2015，35（5）：493-495.
[19] 何涛，王正根，陈宏辉.ENBD及EST在胆总管微小结石所致急性胰腺炎治疗中的价值[J].中南医学科学杂志，2014，42（3）：305-307.
[20] 马上吉，陈旭峰，杨胜兰，等.清胰解毒方配合西药治疗重症急性胰腺炎的疗效及对血清淀粉酶和炎性因子的影响[J].陕西中医，2015，36（10）：1349-1350.
[21] 符爱玉，林芳崇.甲泼尼龙联合生长抑素治疗重症急性胰腺炎的临床研究[J].现代药物与临床，2015，30（9）：1091-1094.
2018, Vol. 15 
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