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| Clinical effect of laparoscopic cholecystectomy in early treatment of cholecystolithiasis complicated with acute biliary pancreatitis |
| HUANG Peng WEI Yi LI Mingwu |
| The First Department of General Surgery, Suzhou Hospital Affiliated to Anhui Medical University, Anhui Province, Suzhou 234000, China |
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Abstract Objective To investigate the clinical effect of laparoscopic cholecystectomy (LC) in the early treatment of cholecystolithiasis complicated with acute biliary pancreatitis. Methods Sixty patients with acute biliary pancreatitis caused by cholecystolithiasis admitted to Suzhou Hospital Affiliated to Anhui Medical University from January 2016 to January 2018 were selected as the study objects, and 30 patients receiving LC treatment within one week of onset were selected as the experimental group; after 10-14 days of conservative treatment, 30 patients who improved and received delayed LC treatment 12 weeks later were treated as the control group. The length of hospital stay, cost of hospital stay, postoperative complications, recurrence of pancreatitis (follow-up for 12 months), alanine aminotransferase + glutamic oxalacetic transaminase (ALT+AST), average alkaline phosphatase (AKP) and C-reactive protein (CRP) values on the first, third and seventh days after surgery were compared between the two groups. Results The length and cost of hospital stay in the experimental group were significantly lower than those in the control group, and the differences were statistically significant (all P ＜ 0.05). One case of bile leakage occurred in both groups after surgery, but were all cured by unobvious drainage. No recurrence of pancreatitis was observed in both group. AST+ALT and average AKP values of the two groups on the third day after surgery were significantly higher than those of the first and seventh days after surgery, and the differences were statistically significant (all P ＜ 0.05). There was no significant difference in AST+ALT and average AKP values between the two groups on the first, third and seventh days after surgery (P ＞ 0.05). CRP value on the first, third and seventh days after surgery in the experimental group was significantly lower than that before surgery, and the differences were statistically significant (all P ＜ 0.05). Conclusion The application of laparoscopic cholecystectomy in the early treatment of cholecystolithiasis complicated with acute biliary pancreatitis is safe and effective, and significantly reduces the length and cost of hospital stay.
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[1] 急性胰腺炎协作组.中国6223例急性胰腺炎病因及病死率分析[J].胰腺病学，2006，6（6）：321-325.
[2] 廖作富，李军，谢江，等.腹腔镜胆囊切除术治疗胆源性胰腺炎的时机分析[J].江苏大学学报：医学版，2017，27（6）：533-535.
[3] 中华医学会消化病学分会胰腺疾病学组，中华胰腺病杂志编辑委员会，中华消化杂志编辑委员会.中国急性胰腺炎诊治指南（2013年，上海）[J].中华消化杂志，2013， 33（4）：217-222.
[4] Sharma P，Aguilar R，Nader MA，et al. Weekend Effect in Acute Pancreatitis-Related Hospital Admissions in the United States： An Analysis of the Nationwide Inpatient Sample [J]. Pancreas，2018，47（4）：418-424.
[5] 赵晖，竺来法，曹文玺，等.早期腹腔镜胆囊切除术在急性胆源性胰腺炎中的应用[J].肝胆胰外科杂志，2016，28（2）：102-104.
[6] 包文中，孟翔凌，汤大纬，等.胆囊结石合并急性胰腺炎早期和延期腹腔镜胆囊切除术临床疗效分析[J].中国普通外科杂志，2013，22（9）：1232-1234.
[7] Papapanagiotou A，Sgourakis G，Peristeraki S，et al. Potential Prediction of Acute Biliary Pancreatitis Outcome on Admission [J]. Pancreas，2018，47（4）：454-458.
[8] Aksoy F，Demiral G，Ekinci ?魻. Can the Timing of Laparoscopic Cholecystectomy After Biliary Pancreatitis Change the Conversion Rate to Open urgery? [J]. Asian J Surg，2018，41（4）：307-312.
[9] Borreca D，Bona A，Bellomo MP，et al. Timing of cholecystectomy in acute biliary pancreatitis：is it still reasonable to wait? [J]. Minerva Chir，2016，71（1）：31-37.
[10] Cox MR，Budge JP，Eslick GD. Timing and nature of presentation of unsuspected retained common bile duct stones after laparoscopic cholecystectomy：a retrospective study [J]. Surg Endosc，2015，29（7）：2033-2038.
[11] 吴雪生，张剑林，王兴宇，等.胆囊结石继发胆源性胰腺炎手术时机及疗效的分析[J].肝胆外科杂志，2018，26（3）：180-183.
[12] 宋兴超，吴磊，路要武.急性胆源性胰腺炎患者行腹腔镜胆囊切除手术时机选择探讨[J].中国普通外科杂志，2018，27（3）：349-354.
[13] 陈胜，吴卫泽，李能平.轻症急性胆源性胰腺炎腹腔镜胆囊切除手术时机的探讨[J].中华胰腺病杂志，2016， 16（5）：326-330.
[14] 冯延平，史东利.轻型急性胆源性胰腺炎一期行腹腔镜胆囊切除术可行性及安全性观察[J].海南医学，2017， 28（7）：1154-1156.
[15] 张阳光，郭忠.胆源性胰腺炎不同手术治疗时机对机体应激和免疫功能的影响[J].中华普通外科学文献：电子版，2018，12（4）：242-245.
[16] 廖作富，李军，谢江，等.腹腔镜胆囊切除术治疗胆源性胰腺炎的时机分析[J].湖南师范大学学报：医学版，2018，15（5）：62-64.
[17] 董汉华，武齐齐，陈孝平.急性胆道感染东京指南（2018版）更新解读[J].临床外科杂志，2019，27（1）：5-9.
[18] 胡凤林，尚东，张浩翔，等.《东京指南（2018）》急性胆道感染诊疗策略更新解读[J].中国实用外科杂志，2018， 38（7）：763-766.
[19] 张俊波.血清C反应蛋白、降钙素原在急性胰腺炎诊治中的应用价值[J].中国当代医药，2020，27（3）：61-64.
[20] 王坤玉，叶春芬.血清PCT、CRP及TNF-α在评估急性胰腺炎中的临床意义[J].中国医药科学，2018，8（9）：174-176，190.
[21] 王丽.急性胰腺炎检测降钙素原与及C反应蛋白的价值分析[J].中国实用医药，2017，12（1）：58-60. |
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