The Research Of Minimally Invasive Surgery On Acute Biliary Pancreatitis

Objective To choose patients of acute biliary pancreatitis, all patients underwent comprehensive treatment including conservative treatment and minimally invasive surgical treatment after being in hospital, summarizing the hospital stay, complication, recurrence and mortality rate of all patients. Expect to investigate an effective method for treating acute biliary pancreatitis.MethodsResearch:45 analytical patients are diagnosed as acute biliary pancreatitis coincident with the golden criteria distributed by Chinese Medical Association. (2007)Selection criteria of patients:(1) Symptoms and signs of acute pancreatitis:Upper or the left upper abdominal pain, abdominal distension, nausea and vomit. Tenderness or rebound tenderness in the left upper abdomen, especially who had the history of biliary colic. (2) The AMY of all patients is at least 3 times higher than the normal one. (3) Imaging examination (Ultrasound, CT or MR) found pancreas be edema before operation. (4) Imaging examination (Ultrasound, CT or MR) found gallstones, expansion of common bile duct or common bile duct stones. (5) Excluding other excuses, such as alcohol, Hyperlipidemia or Hypercalcemia to lead pancreatitis. (6) Vital signs of the patients are stable, and had not any contraindication of pneumoperitoneum.Treatment:(1) All patients received comprehensive treatment such as fasting, Gastrointestinal decompression, fluid infusion, adjust the water media, anti-infective and inhibition of pancreatic enzyme secretion et al, after in hospital. (2) 25 obstructive acute biliary pancreatitis patients received comprehensive treatment, at the same time received ERCP+EST in 72 hours after fall ill, patients whose stone can not be resolved received ENBD, then received LC or LC+LCBD after comprehensive treatment till the symptom and signs recover to normal.20 non-obstructive acute biliary pancreatitis patients received comprehensive treatment, fasting, Gastrointestinal decompression, fluid infusion, adjust the water media, anti-infective and inhibition of pancreatic enzyme secretion et al, then received LC or LC+LCBD when the symptom and signs recover to normal,15-18 days (16.7 days) after inpatient, with T tube drainage.Results:25 obstructive patients,23 patients had their common bile duct stone resolved with duodenoscope,2 patients failed and received ENBD.45 patients received LC,6 of them received LC+LCBD, all operations are successful. All patients had a follow-up time of 0.5-2 years(with a average 1.3 years), no one had complication or relapse.Conclusions:Patients of obstructive acute biliary pancreatitis, should receive ERCP+EST as soon as 72h after fall ill, someone who can not have their common bile duct stone resolved can also receive ENBD, then receive a second operation as LC or LC+LCBD; non-obstructive acute biliary pancreatitis should receive comprehensive treatment first, then have a operation of LC or LC+LCBD in one hospital time.