摘要
目的探讨非梗阻性急性胆源性胰腺炎(acute biliary pancreatitis,ABP)患者急诊行逆行胰胆管造影和Oddi括约肌切开术(endoscopic retrograde cholangiopancreaticography and endoscopic sphincterotomy,ERCP/ES)治疗的效果和价值。方法 142例ABP患者中,轻型急性胆源性胰腺炎(mild acute biliary pancreatitis,MABP)93例,非梗阻性重症急性胆源性胰腺炎(severe acute biliary pancreatitis,SABP)49例。MABP和SABP各随机分为ERCP/ES治疗组和保守治疗组。保守治疗组常规行液体复苏、抑酸、抑酶、保肝、防治感染、早期肠内营养和中药等治疗,ERCP/ES组则在保守治疗基础上于入院24h内急诊行ERCP/ES。MABP和SABP分别比较ERCP/ES和保守治疗的效果,并随访2～3年比较胰腺炎的复发率。结果 MABP急诊行ERCP/ES与相应保守治疗组比较,ΔAPACHEⅡ、腹痛缓解时间、总住院时间、并发症发生率、病死率差异均无统计学意义(P>0.05),但胰腺炎复发率ERCP/ES较保守治疗组降低(P<0.01)。SABP急诊行ERCP/ES与相应保守治疗组比较,ΔAPACHE、缓解腹痛、住院时间、并发症、病死率和胰腺炎的复发率差异均有统计学意义(均P<0.05或P<0.01)。结论 MABP急诊行ERCP/ES,对其并发症、病死率和预后等无明显益处,并有增加相关并发症的风险,而SABP急诊行ERCP/ES可显著改善病情,缩短住院时间,降低并发症和病死率。ABP行ERCP/ES可降低胰腺炎复发率。
Objective To investigate the efficacy and value of emergent（within 24h after admission） endoscopic retrograde cholangiopanereatography（ERCP）and endoscopic sphincterotomy（ES）in patients with non-obstructive acute biliary panereatitis（ABP）.Methods 93 cases with non-obstructive mild acute biliary pancreatitis（MABP） were randomly divided into group A（45 cases,with treatment of ERCP/ES）,group B（48 cases,with conservative treatment） and similar assignment was made to 49 cases of severe acute biliary pancreatitis（SABP）,group C（24 cases of SABP,with treatment of ERCP/ES） and group D（25 cases of SABP,with conservative treatment）.The ERCP/ES treatment groups（group A and group C） underwent emergent ERCP and ES after admission based on the conservative treatments received by group B and group D.The outcomes of ERCP/ES treatment were compared with the conservative group.The recurrence rate was compared between the two therapies with 2~3 years followed-up.Results For SABP,compared with conservative treatment,the ERCP/ES treatment significantly decreased the APACHE II score（ΔAPACHE II）,relieved the abdominal pain（P〈0.01）,shortened the duration of hospital stay and reduced the morbidity and mortality（P〈0.05）.With 2-3 years follow-up,the ERCP/ES treatment group had lower rate of recurrence than the conservative treatment group had（P〈0.05）.For MABP.Conclusion Emergent ERCP/ES can effectively improve the severity of SABP,significantly shorten the hospital stay and decrease the morbidity and mortality of SABP.In addition,ERCP/ES can reduce the recurrence of ABP.
出处
《宁夏医科大学学报》
2011年第11期1033-1035,1044,共4页
Journal of Ningxia Medical University
关键词
急性胆源性胰腺炎
内镜逆行胰胆管造影
内镜括约肌切开术
acute biliary panereatitis（ABP）
endoscopic retrograde cholangiopanereatography
endoscopic sphincterotomy（ES）
