·临床论著·胆囊结石伴急性胆源性胰腺炎的微创治疗肖竣陈海川俞海波金小丹(浙江省温州市中心医院肝胆外科腹腔镜中心，温州325000)【摘要】目的探讨胆囊结石伴急性胆源性胰腺炎(acutebiliarypancreatitis，ABP)的微创治疗方法及手术时机。方法回顾分析我院2008年5月～2013年5月胆囊结石伴ABP122例的临床资料。先保守治疗，磁共振胰胆管成像(MＲCP)明确胆总管有无结石梗阻，104例未发现结石者急性胰腺炎恢复后行腹腔镜胆囊切除术(laparoscopiccholecystectomy，LC)。18例MＲCP发现胆总管下段结石，行内镜逆行胆胰管造影(EＲCP)+十二指肠乳头括约肌切开(EST)取石+鼻胆管引流(ENBD)治疗成功，再行LC。结果轻型106例，手术时间为发病后7～14天;重型16例，手术时间为发病后15～30天。无中转开腹、胆管损伤及死亡。其中107例随访5～8个月，无胰腺炎复发。结论对胆囊结石伴ABP应常规MＲCP检查。未发现胆总管结石者待胰腺炎恢复后行LC;有胆总管结石伴梗阻者72小时内用十二指肠镜取出胆管下端嵌顿结石并ENBD，待胰腺炎恢复后再行LC;无梗阻者保守治疗胰腺炎恢复后，先行EＲCP并取石，再行LC。手术时机应遵循“个体化”原则，一般轻型胰腺炎可在发病1～2周内手术。采用上述方法治疗胆囊结石伴ABP安全、有效、微创、可行。【关键词】胆囊结石;急性胆源性胰腺炎;磁共振胰胆管成像;腹腔镜胆囊切除术;内镜逆行胆胰管造影术中图分类号:Ｒ657．4文献标识:A文章编号:1009－6604(2014)05－0399－03doi:10．3969/j．issn．1009－6604．2014．05．005Mini-invasiveTherapyforAcuteBiliaryPancreatitisAccompanyingGallstonesXiaoJun，ChenHaichuan，YuHaibo，etal．DepartmentofHepatobiliarySurgery，WenzhouCentralHospital，Wenzhou325000，China【Abstract】ObjectiveToexplorethemini-invasivetherapyandtheoperationopportunityforthetreatmentofgallstonewithacutebiliarypancreatitis(ABP)．MethodsThedataof122casesofgallstonewithABPinourhospitalbetweenMay2008andMay2013wereretrospectivelyreviewed．Allpatientsunderwentconventionaltreatmentfirstandmagneticresonancecholangiopancreatography(MＲCP)wasusedtoconfirmwhethertherewasstoneobstructioninthecommonbileduct．The104patientswithoutcholedocholithiasisunderwentlaparoscopiccholecystectomy(LC)aftertheirrecoveryfrompancreatitis．EighteenpatientsdiagnosedascholedocholithiasisbyMＲCPreceivedendoscopictherapy(endoscopicretrogradecholangiopancreatography+endoscopicsphincterotomy+endoscopicnasobiliarydrainage)andthestoneswereremovedsuccessfully，thenLCwasperformed．ＲesultsThe106casesofmildacutepancreatitisunderwentLCwithin7－14daysfollowingtheattack．The16casesofsevereacutepancreatitisunderwentLCwithin15－30daysfollowingtheattack．Casesinthisgrouphadnoconversiontoopensurgery，bileductinjuryordeath．Amongthe122patients，107werefollowedupfor5－8months，andnoacutepancreatitisrecurrencewasfound．ConclusionsForpatientsofgallstonewithABP，MＲCPisaroutinetestbeforethesurgery．Forpatientswithgallstonealone，LCshouldbeperformedaftertheirrecoveryfrompancreatitis．Thepatientswithcholedocholithiasisandbileductobstructionshouldreceiveemergencyendoscopictherapywithin72hours，andLCshouldbeperformedaftertheirrecoveryfrompancreatitis;thepatientswithcholedocholithiasisbutwithoutbileductobstructionshouldreceiveEＲCPfirstandthenLCaftertheirrecoveryfrompancreatitis．Theoperationopportunityshouldbeindividualized．MostofthepatientswithmildacutepancreatitisshouldundergoLCwithin1－2weeksoftheattack．Theabovetreatmentissafe，effectiveandminimallyinvasiveforpatientsofgallstonewithABP．【KeyWords】Gallstone;Acutebiliarypancreatitis;Magneticresonancecholangiopancreatography;Laparoscopiccholecystectomy;Endoscopicretro...
