内镜逆行胰胆管造影术治疗急性胆源性胰腺炎临床观察

Clinical observation of endoscopic retrograde cholangiopancreatography in the treatment of acute biliary pancreatitis

目的内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)是治疗急性胆源性胰腺炎的首选治疗方案,可快速缓解病情并减少复发,本研究分析ERCP术在急性胆源性胰腺炎治疗中的应用及对患者肝功能影响。方法选取2018-01-01-2019-02-01信阳市中心医院收治的急性胆源性胰腺炎患者为研究对象,根据组间具有可比性的原则,选取其中接受常规药物治疗的48例患者纳入对照组,接受ERCP术的48例患者纳入观察组。比较两组患者治疗7d后疗效,比较治疗前及治疗7d后天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、谷氨酰转肽酶(glutamyl transpeptidase,GGT)、C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)水平,比较两组患者临床症状改善时间。结果治疗7d后,观察组显效率为83.33%,高于对照组的62.50%,χ2=7.429,P<0.001。治疗7d后,观察组AST为(46.57±4.12)U/L,低于对照组的(53.64±4.85)U/L,t=7.697,P<0.001;观察组ALT为(50.04±4.58)U/L,低于对照组的(61.10±5.22)U/L,t=11.034,P<0.001;观察组GGT为(62.67±4.85)U/L,低于对照组的(70.23±5.17)U/L,t=7.389,P<0.001。观察组CRP为(2.67±0.62)μg/L,低于对照组的(3.84±0.85)μg/L,t=7.705,P<0.001;观察组IL-6为(5.80±2.40)μg/L,低于对照组的(8.14±3.03)μg/L,t=4.194,P<0.001。观察组恶心呕吐消失时间为(2.94±0.82)d,低于对照组的(4.42±0.80)d,t=8.951,P<0.001;观察组腹痛缓解时间为(6.64±1.10)d,低于对照组的(8.48±1.31)d,t=7.452,P<0.001;观察组体温正常时间为(4.22±1.04)d,低于对照组的(6.17±1.25)d,t=8.308,P<0.001;观察组肠道通气时间为(4.11±1.18)d,低于对照组的(5.47±1.37)d,t=5.211,P<0.001。结论ERCP在急性胆源性胰腺炎治疗中的应用效果良好,对患者肝功能损害较小,能够促进临床症状改善,降低炎症水平。

OBJECTIVE Endoscopic retrograde cholangiopancreatography(ERCP)is the preferred treatment regimen for acute biliary pancreatitis,and it can quickly relieve the disease condition and reduce recurrence,and this study was aimed to analyze the application of ERCP in the treatment of acute biliary pancreatitis and its effects on liver function of patients.METHODS Patients with acute biliary pancreatitis who were treated in Xinyang Central Hospital from January 1,2018 to February 1,2019 were selected as study subjects.According to the principle of comparability between groups,48 patients who received conventional drug treatment were selected and included in control group and 48 patients who received ERCP surgery were included in observation group.The efficacy after 7 dof treatment was compared between the two groups,and the levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT),glutamyl transpeptidase(GGT),C-reactive protein(CRP)and interleukin-6(IL-6)were compared before treatment and after 7 dof treatment,and the improvement times of clinical symptoms were compared between the two groups.RESULTS After7 dof treatment,the markedly effective rate in observation group was significantly higher than that in control group(83.33%vs 62.50%)(χ2=7.429,P<0.001).After 7 dof treatment,the level of AST in observation group was lower than that in control group[(46.57±4.12)U/Lvs(53.64±4.85)U/L,t=7.697,P<0.001].The level of ALT in observation group was lower than that in control group[(50.04±4.58)U/L vs(61.10±5.22)U/L,t=11.034,P<0.001].The level of GGT in observation group was lower than that in control group[(62.67±4.85)U/L vs(70.23±5.17)U/L],t=7.389,P<0.001].The level of CRP in observation group was lower than that in control group[(2.67±0.62)μg/L vs(3.84±0.85)μg/L,t=7.705,P<0.001].The level of IL-6 in observation group was significantly lower than that in control group[(5.80±2.40)μg/L vs(8.14±3.03)μg/L,t=4.194,P<0.001].The disappearance time of nausea and vomiting in observation group was lower than that in control group[(2.94±0.82)d vs(4.42±0.80)d,t=8.951,P<0.001].The time of abdominal pain relief in observation group was lower than that in control group[(6.64±1.10)d vs(8.48±1.31)d,t=7.452,P<0.001].The time of normal body temperature recovery in observation group was significantly lower than that in control group[(4.22±1.04)d vs(6.17±1.25)d,t=8.308,P<0.001].The time of intestinal ventilation in observation group was lower than that in control group[(4.11±1.18)d vs(5.47±1.37)d,t=5.211,P<0.001].CONCLUSION ERCP has good application effects and small damage to liver function in the treatment of acute biliary pancreatitis,and it can promote the improvement of clinical symptoms and reduce the level of inflammation.