复杂胰管结石的腹腔镜手术与开腹手术疗效对比研究
安东均 安琳 张成 韩立 冯金鸽
摘 要
目的：探讨复杂胰管结石采用腹腔镜手术与开腹手术治疗的效果。
方法：回顾性分析咸阳市中心医院肝胆外科2012年3月～2016年5月分别采用腹腔镜（16例，A组）和开腹手术（19例，B组）治疗复杂胰管结石的临床资料。检测2组手术前、后的胰岛素抵抗指数、C-反应蛋白、术中出血量和手术时间、术后应用镇痛药的次数、术后排气时间、腹腔引流管拔除时间、术后住院时间、住院总费用和术后并发症发生情况。按照WHO疼痛分级法评价手术前、后的疼痛等级。
结果：2组患者均临床治愈出院，无围手术期死亡。2组的术中出血量、手术时间比较，A组均优于B组，差异有统计学意义（t=5.487，8.365，P＜0.05）。2组的术前至术后7d胰岛素抵抗指数和C-反应蛋白水平、术后应用镇痛药的次数、术后排气时间、拔除腹腔引流管时间、住院时间及住院总费用情况比较，A组均优于B组，差异有统计学意义（P＜0.05）。2组患者的术后近期并发症比较，差异均有统计学意义（x2=5.232，P＜0.05）。随访时间1～4年，术后1年依据 WHO疼痛分级法评价：腹腔镜手术（A组）治疗有效率为93.8%，常规开腹手术（B组）治疗有效率为73.7%。2组的治疗效果比较，差异有统计学意义（x2=4.426，P＜0.05）。2组手术前、后的糖尿病和腹泻情况相比无明显变化。
结论：复杂胰管结石若选择外科手术治疗，在技术和设备条件具备的情况下优先选用腹腔镜手术，术式选择上应遵循微创化原则，以使患者减轻痛苦和最大限度地受益。
关键词
慢性胰腺炎；胰管结石；腹腔镜；胰管空肠吻合术
Comparative study of laparoscopic and open surgery for complicated pancreatic duct stones
An Dongjun，AN Lin，ZHANG Cheng，HAN Li，FENG Jinge.1 Department of Hepatobiliary Surgery，the Center Hospital of Xianyang City，Xianyang 712000，China；2 School of Statistics，Xi'an University of Finance and Economics，Xi'an 710100，China
Corresponding author:An Dongjun，Email:1158011981@qq.com
ABSTRACT
Objective:To investigate the effect of laparoscopic surgery and open surgery in the treatment of complicated pancreatic duct stones.
Methods:The clinical data of 35 cases of complicated pancreatic duct stones were analyzed retrospectively.16 cases were treated by laparoscopy（group A）and 19 cases were open surgery（group B）from Mar 2012 to May 2016 in the Center Hospital of Xianyang City.Before and after surgery the insulin resistance index（IR），level of serum C-reactive protein，the amount of bleeding during operation and the time of operation，the number of analgesics used after the operation，the exhaust time，the extraction time of the abdominal cavity drainage tube，the postoperative hospital stay，total hospital expenses and postoperative complications were detected.The pain grade was evaluated according to WHO pain classification method before and after operation.
Results:Both groups were cured and discharged without perioperative death.The amount of bleeding and operation time in group A were better than that in group B（t=5.487，8.365，P＜0.05），the difference was statistically significant.The changes of insulin resistance index and serum CRP level before and after operation in the 7th day，number of analgesic drugs，postoperative exhaust time，drainage tube time，postoperative hospital stay and total cost in group A were better than those in group B，the difference was statistically significant（P＜0.05）.There were significant differences in recent complications between the two groups（x2=5.232，P＜0.05）.The follow-up time was 1-4 years，and evaluated according to WHO pain grading method 1 year after operation:the effective rate of laparoscopy group（group A）was 93.8%.In the routine laparotomy group（group B），the effective rate was 73.7%.The treatment effect was compared the difference was statistically significant（x2=4.426，P＜0.05）.There was no significant change in diabetes and diarrhea before and after the operation.
Conclusion:If the complicated pancreatic duct stones are to be operated，laparoscopic surgery is preferred in the case of technical and equipment conditions.The principle of minimally invasive surgery should be followed in the choice of operation，so that patients can alleviate the pain and the greatest extent of benefit.
KEY WORDS
Chronic pancreatitis；Pancreatic duct stones；Laparoscope；Pancreaticojejunostomoy
目前经内镜逆行胰胆管造影（endoscopic retrograde cholangio-pancreatography，ERCP）处理困难的慢性胰腺炎复杂胰管结石仍是胰腺外科治疗的难点和热点。咸阳市中心医院肝胆外科2012年3月～2016年5月采用腹腔镜或开腹手术治疗经ERCP处理困难的慢性胰腺炎复杂胰管结石35例，现报道如下。