摘要
目的探讨梗阻型胆源性胰腺炎内镜治疗的时机与疗效。方法回顾性分析160例梗阻型胆源性胰腺炎患者内镜治疗的临床资料。根据发病后内镜治疗时间分为两组：急诊组78例在发病〈48h行急诊内镜治疗；延期组82例在早期非手术治疗基础上于发病≥48h行延期内镜治疗。结果两组内镜治疗总成功率为96．2％（154／160）。急诊组腹痛缓解时间[（4．98±1．75）d]、实验室指标恢复正常时间[（10．08±5．22）d]以及住院时间[（12．24±7．20）d]均显著低于延期组[分别为（5．54±2．53）、（12．93±6．60）、（16．38±6．94）d]（P〈0．05或〈0．01）。重症梗阻型胆源性胰腺炎急诊组术后总并发症发生率（9．6％，5／52）显著低于延期组（23．6％，13／55）（P〈0．05），两组病死率比较差异无统计学意义（P〉0．05）。结论重症梗阻型胆源性胰腺炎应在发病48h内行急诊内镜治疗；轻症患者如早期非手术治疗无效或出现急性胆道感染症状，亦应争取及时行急诊内镜治疗。
Objective To investigate the timing of endoscopic therapy of obstructive acute biliary pancreatitis. Methods One hundred and sixty cases of obstructive acute biliary pancreatitis treated by endoscopy were analyzed. The patients were divided into two groups ： 78 cases received emergency endoscopic therapy （ EE group ） within 48 hours from onset of symptoms, including endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy,with or without stone extraction and endoscopic nasobiliary drainage;82 cases received delay endoscopic therapy （DE group）after initial 48 hours of conservative management. Results The total success rate of therapeutic endoscopy was 96.2 % （154/160）. In EE group, the time for disappearance of abdominal pain [ （4.98 ± 1.75 ） d ], the time for laboratory recovery [ （ 10.08 ± 5.22） d] ,and the length of hospitalization [ （12.24 ±7.20） d] were significantly shorter than those in DE group [ （5.54 ±2.53 ）, （ 12.93 ± 6.60）, （ 16.38 ± 6.94） d ] （P 〈 0.05 or 〈 0.01 ）. In cases with severe acute biliary pancreatitis,the morbidity in the EE group （9.6% ,5/52） was significantly lower than DE group （23.6%, 13/55 ）（P 〈 0.05 ）, but the difference in mortality rate between the two groups was not significant （P 〉 0.05）. Conclusions In severe acute biliary pancreatitis patients with biliary tract obstruction, emergency endoscopic therapy should be performed within 48 hours from the onset of symptoms. Patients with mild acute biliary pancreatitis should also undergo prompt endoscopic therapy after ineffective conservative management or appearance of symptoms of acute biliary tract infection.
出处
《中国医师进修杂志》
2010年第20期14-16,共3页
Chinese Journal of Postgraduates of Medicine
关键词
胰腺炎
胆汁淤积
手术后并发症
治疗
Pancreatitis
Cholestasis
Postoperative complications
Therapy
