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目的:探讨梗阻型轻症急性胆源性胰腺炎(MABP)的最佳治疗方案。方法:回顾性分析2008—2014年收治的132例梗阻型MABP患者的临床资料。其中35例行以内镜逆行胆胰管造影为基础的微创治疗(内镜组),43例行腹腔镜下胆囊切除、胆总管探查术(腹腔镜组),54例行开腹手术(开腹组)。比较各组的相关临床指标。结果:内镜组、腹腔镜组、开腹组间的腹痛缓解时间(3.31d vs.3.84d vs.7.65d)、白细胞恢复正常时间(4.20d vs.5.35d vs.8.72d)差异均有统计学意义(均P<0.05);内镜组与腹腔镜组的血淀粉酶恢复正常时间(3.26d vs.3.53d)、住院时间(9.49d vs.9.30d)差异无统计学意义(均P>0.05),但均短于开腹组(4.35d、9.30d)(均P<0.05)。3组的治愈率均为100%,均无死亡病例,并发症发生率差异无统计学意义(P>0.05);内镜组术后1年内胰腺炎复发率(42.86%)明显高于腹腔镜组(0.00%)和开腹组(1.85%)(均P<0.05),但后两组间差异无统计学意义(P>0.05)。结论:对于梗阻型MABP,在大多数情况下,腹腔镜途径是解除胆道梗阻的首选方法。
Objective: To investigate the best treatment of obstructive mild acute pancreatitis (MABP). Methods: The clinical data of 132 obstructive MABP patients admitted from 2008 to 2014 were analyzed retrospectively. Among them, 35 patients underwent minimally invasive endoscopic retrograde cholangiopancreatography (endoscopic group), 43 underwent laparoscopic cholecystectomy, common bile duct exploration (laparoscopic group), and 54 underwent open surgery Abdominal group). Compare the clinical indicators of each group. Results: The pain relief time (3.31d vs.3.84d vs.7.65d), normal time of leukocyte recovery (4.20d vs.5.35d vs.8.72d) in endoscopic group, laparoscopic group and open group all had significant difference (All P <0.05). There was no significant difference between the endoscopic group and the laparoscopic group in the recovery time of blood amylase (3.26d vs.3.53d) and hospital stay (9.49d vs.9.30d) P> 0.05), but both were shorter than those in the open group (4.35d, 9.30d) (all P <0.05). The cure rates of the three groups were all 100%, no deaths were found, the incidence of complications was not significantly different (P> 0.05). The recurrence rate of pancreatitis (42.86%) in the endoscopic group was significantly higher than that of laparoscopy Group (0.00%) and open group (1.85%) (all P <0.05), but there was no significant difference between the two groups (P> 0.05). Conclusions: For obstructive MABP, the laparoscopic approach is the preferred method of relieving biliary obstruction in most cases.