胰腺中段切除术与3cm胰腺支架ERCP术对交通事故致胰腺损伤干预研究

Intervention of pancreatic injury caused by traffic accidents by mid-pancreatic resection and 3 cm pancreatic stent ERCP

目的分析胰腺中段切除术与3cm胰腺支架经内镜逆行性胰胆管造影术(ERCP)对交通事故致胰腺损伤患者术后胰腺炎、胰瘘发生率及血清降钙素原(PCT)、C反应蛋白(CRP)指标影响。方法2014年1月-2018年1月郑州大学附属南阳医院收治交通事故致胰腺中段损伤患者40例,分别采用3cm胰腺支架ERCP术(ERCP组)和胰腺中段切除术(切除术组)治疗,各20例。ERCP组中男性14例,女性6例;年龄18~57岁,平均38.9岁;切除术组男性15例,女性5例;年龄18~62岁,平均39.2岁。观察两组患者手术时间、住院时间、术中出血量、术后4周胰腺炎及胰瘘发生率,手术前及术后4周时检测患者PCT及CRP水平。结果两组患者手术时间差异无统计学意义。ERCP组术中出血量及住院时间分别为(183.28±13.22)mL、(9.28±1.32)d,均显著低于切除术组(240.12±15.35)mL、(11.32±2.09)d,差异有统计学意义(P<0.05);术后半年内ERCP组胰腺炎及胰瘘发生率分别为5.00%及5.00%,低于切除术组的15.00%和25.00%,差异有统计学意义(P<0.05);术后4周ERCP组血液中PCT及CRP水平分别为(0.83±0.09)ng/mL、(46.19±7.21)mg/L,均显著低于ERCP组(1.22±0.11)ng/mL、(103.28±10.43)mg/L(P<0.05)。结论相较于胰腺中段切除术,采用3cm胰腺支架ERCP术治疗交通事故致胰腺损伤患者可显著降低患者术后胰腺炎、胰瘘的发生率,并改善患者血液中PCT及CRP水平。

Objective To analyze the effects of mid-pancreatic resection and ERCP with 3 cm pancreatic stent on the incidence of pancreatitis,pancreatic fistula and serum procalcitonin(PCT)and C-reactive protein(CRP)in patients with pancreatic injury after traffic accident.Methods From Jan.2014 to Jan.2018,40 patients with mid-pancreatic injury caused by traffic accidents were divided into 3 cm pancreatic stent ERCP(ERCP group)and mid-pancreatic resection(resection group)according to different surgical methods,with 20 cases in each group.There were 14 males and 6 females in ERCP group,aged 18-57,with an average age of 38.9 years;15 males and 5 females in ERCP group,aged 18-62,with an average age of 39.2 years.The operation time,hospitalization time,intraoperative bleeding volume,incidence of pancreatitis and pancreatic fistula within six months after operation were observed.PCT and CRP levels were measured before operation and 4 weeks after treatment.Results There was no difference in operation time.The bleeding volume and hospitalization time in ERCP group were(183.28±13.22)mL and(9.28±1.32)d,which were significantly lower than those in resection group(240.12±15.35)mL and(11.32±2.09)d(P<0.05).The incidence of pancreatitis and pancreatic fistula in ERCP group was 5.00%and 5.00%respectively within half a year after treatment,which were lower than those in resection group(15.00%and 25.00%).The levels of PCT and CRP in blood of ERCP group were(0.83±0.09)ng/mL,(46.19±7.21)mg/L at 4 weeks after treatment,which were significantly lower than those of resection group(1.22±0.11)ng/mL and(103.28±10.43)mg/L(P<0.05).Conclusion Compared with mid-pancreatic resection,ERCP with 3 cm pancreatic stent can significantly reduce the incidence of post-operative pancreatitis and pancreatic fistula,and improve the levels of PCT and CRP in patients with pancreatic injury caused by traffic accidents.