Clinical Analysis Of Double-mirror Combined With Traditional Laparotomy In The Treatment Of Acute Biliary Pancreatitis

Objective To investigate the choice of clinical effect and timing of endoscopic retrograde cholangiopancreatography(ERCP)combined with laparoscopic cholecystectomy(LC)and traditional open surgery in the treatment of acute biliary pancreatitis.Methods The patients diagnosed as acute biliary pancreatitis in the Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University from April 1,2013 to January 1,2018 were selected.Through retrospective analysis,patients who met the inclusion criteria were divided into ERCP + LC group and open cholecystectomy + exploration of common bile duct + T tube drainage / primary suture group.The ERCP group was further divided into emergency operation group(within 48 hours of onset)and delayed operation group(over 48 hours of onset)according the timing of operation..The stone clearance rate,intraoperative bleeding volume,gastrointestinal tract recovery time,hospitalization time,hospitalization expenses and the incidence of postoperative complications were recorded and compared.The clinical efficacy of ERCP+LC and open cholecystectomy+common bile duct exploration and ERCP in the treatment of acute biliary pancreatitis was analyzed.Results A total of 146 patients were enrolled in this study.80 patients were in ERCP group and 66 patients were in open group.The ERCP group was further divided into four subgroups according to whether or not obstruction occurred and the timing of operation.The general data of all groups what were age,sex,white blood cell count(WBC),total bilirubin(TBIL),albumin(ALB),alanine aminotransferase(ALT),and gamma-glutamyltransferase(GT)was difference Significanly and has comparability(P > 0.05).Among the indexes ofERCP group and laparotomy group after operation,the recovery time of gastrointestinal tract,hospitalization expenses,intraoperative bleeding volume and the incidence of complications after operation in ERCP group and laparotomy group had statistical significance(P < 0.05),but there was no significant difference in hospitalization time and stone clearance rate between ERCP group and laparotomy group(P > 0.05).The ERCP group was further divided into four subgroups according to whether or not biliary obstruction occurred and the timing of operation.In the combined with biliary obstruction group,there were no significant differences in the recovery time of gastrointestinal tract,hospitalization time,hospitalization expenses,stone clearance rate and intraoperative bleeding between the emergency group and the delayed group(P > 0.05);In the non-combined biliary obstruction group,there were no significant differences in the recovery time and stay of gastrointestinal tract between the emergency group and the delayed group(P > There was no significant difference in hospital time,hospitalization expenses and intraoperative bleeding volume(P > 0.05).Conclusion ERCP+LC has more advantages than open surgery.ERCP can quickly relieve biliary obstruction and achieve the same therapeutic effect as open surgery.It has the advantages of simple operation,less trauma,low risk,fast recovery of gastrointestinal tract,less bleeding during operation and low incidence of complications after operation.It is a safe and effective method for the treatment of acute biliary pancreatitis(ABP).It is worth of popularizing in clinic.When to perform surgical treatment was according to the principle of individualization,conservative treatment should be performed first.After the general condition of the patients is improved and the symptoms of pancreatitis are alleviated,surgical treatment should be performed.However,patients with complete obstruction,progressive aggravation of jaundice,progressive dilatation of bile duct,persistent elevation of amylase in blood and urine,and complicated with cholangitis should be treated urgently.