Step by step treatment around pancreatic region with minimally invasive surgery for severe acute pancreatitis  FAN Ying-fang，FANG Chi-hua，XIANG Nan，et al. Department of Hepatobiliary SurgeryⅠ，Zhujiang Hospital of Southern Medical University，Guangzhou 510282，China
Corresponding author:FANG Chi-hua，E-mail：fangch_dr@126.com
Abstract    Objective    To investigate the clinical effect of step by step minimally invasive surgery around pancreat region for patients with severe acute pancreatitis（SAP）. Methods    Thirty-six patients with SAP admitted between September 2003 and October 2009 at the Department of Hepatobiliary SurgeryⅠ，Zhujiang Hospital of Southern Medical University were performed medical treatment. At the same time, patiens were also given minimally invasive treatments step by step. step1：With local anesthesia，patients were put the home-made double drainage tube in peritoneal cavity around the region of pancreas, and patiens with acute suppurative cholangitis (ASC) also performed by emergency surgery such as endoscopic sphincterotomy (EST) or endoscopic nasobiliary drainage (ENBD). Through double drainage tube, all patient’s cavity was persistently douched using 0.5% 5-FU saline solution. step2：After the symptoms of SAP was controlled, patients with biliary stone were performed by laparoscopically operations including laparoscopic cholecystectomy(LC), laparoscopic common bile duct lithotomy, EST, etc. Results    All 36  SAP patients  were performed with full of minimally invasive therapy successfully. Patient’s drainage fluid amylase concentration, blood amylase concentration and leukocytes were decreased significantly after one week（t=2.68, P=0.013；t=2.41, P=0.028；t=2.32, P=0.035）. The cure rate, improvement rate and mortality rate of 36 cases was 94.44%, 100% and zero respectively. Conclusion    Step by step minimally invasive surgical treatment around pancreatic region for SAP have many advantages including minimally invasive, few complications and significant effect. The therapeutic schedule should have potential value for clinical application.