急性胰腺炎病因和诊治十年变迁(附725例报道)

Changes in Etiology, Diagnosis and Therapeutics in Patients with Acute Pancreatitis during the Past Ten Years: A Retrospective Study of 725 Cases

背景急性胰腺炎的病因和早期诊治一直是临床医师关注的问题。目的探讨近十年来急性胰腺炎病因、诊断和治疗的变迁及其对预后和住院费用的影响,总结急性胰腺炎的治疗经验。方法采用回顾性临床研究方法,将725例入选患者分为两组,1993年4月～1998年12月就诊的患者为第一组,1999年1月～2002年8月就诊的患者为第二组;分析两组患者病因、诊断指标、治疗方案、并发症、预后、住院费用方面的变化。结果比较两组病因,两组患胆囊炎胆结石者分别占72.3%和75.8%,高脂血症者分别占25.3%和25.8%,酗酒者分别占10.6%和9.7%。血清淀粉酶水平高于正常上限3倍的总检出率为66.9%,CT诊断总阳性率为92.0%。第一组46.9%的患者应用生长抑素,31.1%的重症患者发生胰腺假性囊肿,2.2%发生胰腺脓肿,死亡率为15.6%。第二组72.3%的患者应用生长抑素,13.2%的重症患者发生胰腺假性囊肿,2.2%发生胰腺脓肿,死亡率为6.5%。第二组的住院费用与第一组相比呈下降趋势,但无显著差异。结论胆道疾病仍为急性胰腺炎的主要病因,血清淀粉酶和CT是急性胰腺炎较常用和可靠的检查手段。通过早期足量应用胰酶抑制剂(尤其是生长抑素)、肠道去污和改善胰腺微循环,可改善急性胰腺炎的预后,降低并发症发生率、死亡率和住院费用。

Background: The etiology, early diagnosis and early treatment of acute pancreatitis have received great attention in recent years that being a common interest for clinicians. Aims: To investigate the changes of etiology, diagnosis and therapeutics in patients with acute pancreatitis during the past ten years, as well as their effects on the prognosis and hospitalization expenses, and to summarize the experiences in the treatment of acute pancreatitis. Methods: In this retrospective clinical trial, 725 enrolled patients were allocated into two groups for analysis of the changes of etiology, diagnostic criteria, therapeutic regimens, complications, prognosis and hospitalization expenses. Patients from April 1993 to December 1998 were recruited into the first group and those from January 1999 to August 2002 constituted the second group. Results: Comparing the etiology of the two groups, cholecystitis and gallstone were about 72.3% in the first group and 75.8% in the second group, hyperlipidemia in 25.3% and 25.8%, alcoholic disease in 10.6% and 9.7%, respectively. Patients having serum amylase 3 times higher than the upper normal limit were 66.9%. Around 92.0% had cute pancreatitis confirmed by CT scan. In the first group, 46.9% of patients received somatostatin; pancreatic pseudocyst occurred in 31.1% of the severe cases, and pancreatic abscess in 2.2%; the mortality rate was 15.6%. In the second group, 72.3% of patients received somatostatin; pancreatic pseudocyst was present in 13.2% of the severe cases, and pancreatic abscess in 2.2%; the mortality rate was 6.5%. The cost of hospitalization in the second group showed an insignificant decline as compared with that of the first group. Conclusions: Biliary diseases are still the primary etiology of acute pancreatitis. Serum amylase and CT scan are reliable diagnostic methods for acute pancreatitis. A favorable prognosis and notable reduction in complications, mortality and hospitalization costs can be achieved by early and adequate doses of pancreatic enzyme inhibitors (especially the somatostatin), intestinal decontaminants, and improvement of pancreatic microcirculation.