Operation time on biliary duct stone with acute gallstone pancreatitis
10.3760/cma.j.issn.1674-1935.2015.01.003
- VernacularTitle:急性胆源性胰腺炎胆道结石手术时机的探讨
- Author:
Yuqing GU
;
Hongxing XU
;
Yiqing WANG
- Publication Type:Journal Article
- Keywords:
Pancreatitis;
Gallstones;
Surgical procedures,operative
- From:
Chinese Journal of Pancreatology
2015;15(1):10-13
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate operation time on biliary duct stone with acute gallstone pancreatitis.Methods The clinical data of 44 patients with acute gallstone pancreatitis who were admitted to Department of General Surgery,Taicang First People's Hospital for surgical management from January 2011 to December 2013 were retrospectively analyzed.Patients were divided into early surgery group and delayed surgery group according to the timing.Early surgery group was defined as the patients whose symptoms of pancreatitis were basically disappeared after conservative treatment and surgery was performed within two weeks,while delayed surgery group was defined as the patients who underwent surgery after two weeks.Results Of the 44 acute gallstone pancreatitis cases,18 patients were males,and 26 were females,with median age of 54 years old (range 26-83 years old).Forty-two cases were mild acute pancreatitis and the other two cases were severe acute pancreatitis.Preoperative imaging indicated both cholecystolithiasis and choledocholithiasis in 5 patients,cholecystolithiasis alone in 39 patients.The 5 patients underwent cholecystectomy and choledocholithotomy with T-tube drainage.Among these 5 cases,one patient with concomitant acute suppurative cholangitis had an emergency surgery,two patients with Ranson score ≤3 had early surgery,and two patients with Ranson score ≥4 had delayed surgery,and all the patients were cured and discharged.Thirty-nine cases with cholecystolithiasis alone were treated with laparoscopic cholecystectomy.Among the 39 patients,25 patients underwent early laparoscopic cholecystectomy,and the other 14 patients underwent delayed surgery,and all the patients were cured and discharged.When compared with delayed group,the average age and Ranson score of early group were lower [(46 ± 12) yrs vs (64 ± 11) yrs and (1.0 ± 0.5) vs (1.5 ± 0.8)],and the median hospital length of stay and the cost were significantly less in the early group than those in the delayed group [(14.0 ± 2.8) d vs (18.1 ± 3.3) d and (17 899 ± 3461) Yuan vs (23 710 ± 3230) Yuan],and the difference between the two groups was statistically significant (P＜0.05).Nevertheless,there was no difference between the operation time and recovery time.There was no conversion to open surgery or post-operative complication in the two groups.Conclusions For severe acute pancreatitis,the delayed operation is recommended when the symptom of pancreatitis is completely improved after conservative management,while for mild acute pancreatitis,early surgery does not increase operation difficulty and complication,and it can decrease the length of hospital stays and costs.
