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

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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.

Key words： Severe acute pancreatitis Laparoscopic surgery Endoscopic nasal biliary (pancreatic) drainage

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LIU Ning. Effect of early laparoscopic surgery combined with endoscopic nassl biliary (pancreatic) drainage in the treatment of severe acute pancreatitis patients[J]. 中国医药导报, 2018, 15(4): 77-81.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2018/V15/I4/77

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