| Background and objectives:Acute pancreatitis is one of the most common digestive system diseases.Acute biliary pancreatitis is a common type of acute pancreatitis,gallstone is the most common etiology,its prevention and treatment is represented by laparoscopic cholecystectomy.Laparoscopic cholecystectomy has gradually become the gold standard for surgical treatment of gallbladder diseases over the past two decades.This study through the observation of acute biliary pancreatitis changes in patients with early and delayed laparoscopic cholecystectomy preoperative and postoperative clinical and laboratory indicators,to explore a hospital experience for such patients treated with laparoscopic cholecystectomy,and summed up the experience in clinical practice,the formation of the hospital room undergraduate treatment plan is consistent with the actual situation of their own,make guidance for the future clinical work better,relieve pain and promote the speedy recovery of patients.Methods: a total of 78 patients who were hospitalized and diagnosed as cholecystolithiasis and acute pancreatitis in Changde First People’s Hospital during January 2013-2017 December were collected.78 patients were divided into early group(n=46)and delayed group(n=32)by retrospective cohort study.First of all,the general data of 78 patients were recorded,including routine blood routine at admission,serum amylase,intraoperative blood loss,intraoperative operation time,total hospital stay,total hospitalization expenses,incidence of postoperative complications,recurrence rate of pancreatitis,postoperative blood routine.The results of amylase and so on were recorded,sorted and statistically analyzed by Excel 2003、Empower and R software.Then,a table was drawn to compare the results of the relevant data and a repeated measurement random effect model was used to plot the white blood cell count,neutrophil 100% and serum amylase over time in 78 patients before and after surgery.The trend and regularity of the curve are analyzed by adjusting the mixed factors which affect the changes of the observed indexes.Finally,the results of the two groups of data are analyzed and compared,and the conclusion is drawn.Results:1.Two groups of patients general situation comparison: two groups in age,weight,course of disease,gender,basic diseases,Ranson score and other aspects compared P values were all higher than 0.05,the difference was not statistically significant,and the comparability between groups was comparable.2.Comparison of clinical indexes between the two groups: the time of operation and the incidence of postoperative complications were compared between the two groups,and the p value before and after correction of confounding factors by regression analysis were all more than 0.05,there was no significant difference between the two groups.The intraoperative bleeding volume was adjusted by regression analysis for confounding factors(p<0.05),the difference was statistically significant,while the total hospital stay,total hospitalization expenses,recurrence of acute pancreatitis were compared.The p value before and after correction of confounding factors by regression analysis was less than 0.05,and the difference was statistically significant.3.Comparison of laboratory indexes between the two groups: at admission,on the first day after operation,and on the third day after operation,the laboratory indexes of the two groups were all above 0.05 before the adjustment of the confounding factors,there was no statistical significance between the two groups,and there was no statistical significance between the two groups.There was no significant difference in p value after correction of confounding factors by regression analysis.4.The laboratory parameters of the two groups were analyzed by repeated measurement of random effect model.The results showed that the white blood cell count,neutrophil 100% ratio and amylase content were linearly correlated with time at admission,on the first day after operation and on the third day after operation.The white blood cell count and the percentage of neutrophils increased at first and then decreased with time,and the changes of serum amylase showed a downward trend with the change of time,compared with p > 0.05,the difference was not statistically significant.Conclusion:1.Laparoscopic cholecystectomy in patients with cholecystolithiasis and acute pancreatitis within 2 weeks is safe and effective,and can significantly reduce the total hospital stay and cost.2.Cholecystectomy after symptom control in patients with cholecystolithiasis and acute pancreatitis can significantly reduce the recurrence rate of pancreatitis. |
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