Analysis The Therapeutic Effect On Early Gallbladder-preserving Operation Of Gallbladder Stones With Non Obstructive Mild Acute Biliary Pancreatitis

Acute biliary pancreatitis is the main type of acute pancreatitis in China,and gallbladder stones has been proved to be a pathogenic factor.The course of non obstructive MABP with gallbladder stones is 1-2 weeks,after 7 days of conservative treatment,most of the clinical symptoms can be relieved,laparoscopic cholecystectomy is usually applied to solve the problem of gallstone and avoid long-term recurrence in clinic,but complications are the problems of surgery.With the application of fiber choledochoscopy,The development of endoscopic minimally invasive gallbladder-preserving operation tends to mature,it has been carried out in China,with less complications,and the characteristics of minimally invasive and retained gallbladder function is expected to provide a new choice for the treatment of such diseases.Objective:To investigate the therapeutic effect of laparoscopic choledochoscopy assisted removal of cholecystolithotomy(LRCL)on the early lines of non obstructive mild acute biliary pancreatitis(MABP)with gallbladder stones,analysis and compare the surgical advantages of LRCL to laparoscopic cholecystectomy(LC).Methods:The clinical data of 93 cases of non obstructive MABP with gallbladder stones in our hospital between Jan 2014 to March 2017 were retrospectively reviewed.51 cases underwent LRCL,32 cases in early group,19 cases in delayed group,22 cases in LC group and 20 cases in conservative treatment group,patients with acute cholecystitis with the exception.All patients underwent conventional treatment first,after 7 to 10 days the early group underwent LRCL and LC group underwent LC,the delayed group underwent LRCL when readmission after 6 weeks,with 1 year followed-up.Collected the clinical data of four groups,indicators included: the postoperative amylase,alanine aminotransferase and the aggravation cases of pancreatitis,operation time,intraoperative blood loss,surgical complications,postoperative diarrhea cases and hospitalization days,the gallstone recurrence rate,the recurrence rate of pancreatitis.Sorted out data and established the database,analysised of SPSS 19 statistics software.All measurement data expressed mean±standard deviation and used single factor ANOVA test,the count data were checked by chi square test,and the difference was statistically significant in P<0.05.Results:All the operation successful,compared the pancreatitis recurrence rate,conservative treatment group of is high than other groups(P<0.05).Compared postoperative amylase,alanine aminotransferase and the aggravation cases of pancreatitis,there were no statistically difference between early group,delayed group and LC group(P>0.05).LRCL groups were significantly superior to LC group in operationtime,intraoperative blood loss,postoperative complications and postoperative diarrhea(P<0.05).The hospitalization days in the early group was significantly shorter than that in the delayed group(P<0.05),the gallbladder contraction function recovered well,the recurrence rate of gallbladder stone was no statistically difference.Conclusion:Gallbladder stones with non obstructive MABP can be treated conservatively first,and LRCL is safe and feasible for patients at early(7~10d)after the clinical symptoms have been relieved,LRCL has better surgical advantage than LC.