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目的探讨腹腔镜和内镜联合治疗在急性梗阻型胆源性胰腺炎中的应用价值。方法 2007～2011年收治的28急性梗阻型胆源性胰腺炎患者采用腹腔镜和内镜联合治疗的方式,对其临床资料进行回顾分析。结果 6例行急诊腹腔镜手术,其中1例中转开腹。其余5例术后2～4周行二期内镜取出残留的胆总管结石;22例行急诊内镜治疗,其中2例治疗时插管失败,改为急诊开腹手术,其余20例于急性胰腺炎缓解后2～6周行二期腹腔镜手术。本组无死亡病例,急诊内镜治疗无消化道出血、肠穿孔等内镜操作相关并发症。急诊腹腔镜术后出现胆漏1例、肺部感染1例,均经保守治疗后痊愈。随访8月～4年,未见急性胰腺炎复发。结论腹腔镜和内镜联合是治疗急性梗阻型胆源性胰腺炎的有效微创手段,值得临床推广应用。
Objective To investigate the value of laparoscopic and endoscopic combined treatment in acute obstructive biliary pancreatitis. Methods A total of 28 patients with acute obstructive biliary pancreatitis admitted from 2007 to 2011 were retrospectively analyzed by means of laparoscopy and endoscopic combined therapy. Results of 6 cases of emergency laparoscopic surgery, of which 1 case laparotomy. The remaining 5 cases were treated with secondary endoscopic removal of residual common bile duct stones after 2 to 4 weeks of operation. Twenty-two patients underwent emergency endoscopy, of which 2 cases failed intubation during treatment and were replaced by emergency laparotomy while the remaining 20 cases were treated with acute Two to six weeks after the remission of pancreatitis, laparoscopic surgery. No deaths in this group, emergency endoscopic treatment of gastrointestinal bleeding, intestinal perforation and other endoscopic operations related complications. One case of bile leakage and one case of pulmonary infection after emergency laparoscopic surgery were cured after conservative treatment. Follow-up from August to 4 years, no recurrence of acute pancreatitis. Conclusion Laparoscopy and endoscopic combination is an effective minimally invasive treatment of acute obstructive biliary pancreatitis, which is worthy of clinical application.