The Research Of Clinical Characteristics And Operative Timing Of Acute Biliary Pancreatitis

Part One:Clinical characteristics of acute biliarry pancreatitisObjective To investigate the clinical features of acute biliary pancreatitis(ABP)and to improve the understanding of ABP.Methods 1013 patients with acute biliary pancreatitis(ABP)and 378 patients with hyperlipidemic acute pancreatitis(HLAP)admitted to the First Affiliated Hospital of Soochow University From January 1,2012 to December 31,2017 were analyzed,including age,gender,disease severity and the levels of serum amylase(AMY),triglyceride(TG),white blood cell(WBC),alanine transaminase(ALT),gamma-glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),total bilirubin(TBIL)within 24 hours after admission.Statistical methods were used to analyze the above two groups of data retrospectively.Results(1)The average age was(57.89 ± 16.73)years in ABP group,with 236 cases(23.3%)in young group(<45 years old)and 484 cases(47.8%)in elderly group(≥ 60 years old).The average age of HLAP group was(40.71±11.24)years.with 250 patients(66.1%)in young group(<45 years old)and 20 patients(5.3%)in elderly group(≥ 60 years old).The age of onset in ABP group was significantly higher than that in HLAP group,especially in elderly patients.Patients in HLAP group were more common in young patients.Difference between the two groups was significant(P<0.05).The male to female ratio was 0.94:1 in ABP group and 2.09:1 in HLAP group.There was a significant difference between the two groups(P<0.01).(2)The levels of AMY,WBC,ALT,GGT,ALP and TBIL in APB group were significantly higher than those in HLAP group,with a significant difference between the two groups(P<0.01).(3)There were 883 cases(87.2%)of mild acute pancreatitis(MAP),79 cases(7.8%)of moderate severe acute pancreatitis(MSAP)and 51 cases(5.0%)of severe acute pancreatitis(SAP)in ABP group.There were 294 cases(77.8%)of MAP,52 cases(13.8%)of MSAP and 32 cases(8.5%)of SAP in HLAP group,with a significant difference between the two groups(P<0.05).Conclusion The onset age of ABP patients was higher than that of HLAP patients and most of them were older women over 60 years old.Most of them were MAP.The level of AMY was significantly increased,and the laboratory indexes of WBC,ALT,GGT,ALP and TBIL were significantly increased.HLAP patients are more common in young men.The incidence of MSAP and SAP was high.The level of AMY was not significantly increased and the level of TG was significantly increased.Part Two:Optimal timing of laparoscopic cholecystectomy in mild acute biliary pancreatitisObjective To explore the optimal opportunity of laparoscopic cholecystectomy(LC)in patients with mild acute biliary pancreatitis(MABP).Methods From January 1,2012 to December 31,2017,A total of 192 patients with MABP who admitted to The First Affiliated Hospital of Soochow University were retrospectively assessed.According to the different operation time after hospitalization,the patients were divided into 5 groups:within 2 weeks,2-4 weeks,4-8 weeks,8-24 weeks and 24 weeks later.The total hospitalization time and recurrence rate of acute biliopancreatic disease were compared between the 5 groups.Results LC was successfully performed in 192 patients.There was no significant difference in surgical difficulty and postoperative recovery between the 5 groups(P>0.05).The total hospitalization time of within 2 weeks and 2-4 weeks operation group was significantly shortened than other groups,and the difference was statistically significant(P<0.05).Moreover,the recurrence rate of within 2 weeks group was 0%while waiting for surgery,which was statistically significant when compared to the other four groups(P<0.05).Conclusion For patients with MABP,LC is safe and feasible within 2 weeks,which can significantly shorten the total hospitalization time,and reduce the recurrence rate of acute biliopancreatic disease while waiting for surgery.