急性胆源性胰腺炎复发的预防

Clinical prevention of recurrence of acute biliary pancreatitis.

目的探讨急性胆石性胰腺炎复发的预防方法。方法对1999年1月～2001年7月入院并治愈的112例急性胆石性胰腺炎患者的临床资料进行分析、随访。所有患者均为首次发病且未行胆囊切除术。根据是否行内镜下Oddi括约肌切开术（endoscopic sphincterotomy，EST）。将所有患者分为EST组和非EST组，并根据是否行胆囊切除术进一步分组，比较各组胆石性胰腺炎复发率。结果平均随访18．5个月（6～30个月）。EST组38例，其中16例行胆囊切除术，均无胆石性胰腺炎复发（0／38）；非EST组74例，14例胆石性胰腺炎复发（14／74），复发率为18．9％，两组有显著差异（P〈0．01）。在非EST组中，胆囊切除29例，2例胆石性胰腺炎复发（2／29），复发率为6．9％；未作胆囊切除45例。12例胰腺炎复发（12／45），复发率为26．7％，胆囊切除后胰腺炎复发率显著降低（P〈0．05）。复发距患者出院时间为2周至2年不等。对2例胆囊切除术后复发的胆石性胰腺炎行ERCP，均发现有胆总管结石，EST后，无胰腺炎发作。结论EST能有效预防胆石性胰腺炎复发，并具有创伤小、恢复快等优点，适合于高龄、一般情况差、不能耐受手术的患者；胆囊切除能降低胰腺炎复发率，胆总管结石是胆囊切除术后胰腺炎复发的主要原因。

Objective To explore clinical strategies of preventing recurrence of acute gallstone pancreatitis. Methods Clinical data of 112 consecutive cases of cured acute gallstone pancreatitis from January 1999 to July 2001 were analyzed and followed up. Before admission no patients were found to have gallstone pancreatitis or a history of cholecystectomy. All cases were divided into EST group or non-EST group according to whether EST （Endoscopic Sphincterotomy ）was performed or not. The incidence of recurrent pancreatitis in each group was compared. Results Median follow-up after discharge was 18.5months（range 6 - 30）. None had recurrent pancreatitisin all 38 cases of ESTgroup （0/38）, including 16 patients who underwent cholecystectomy; of 74 cases of non-EST group, 14 had recurrent pancreatitis （14/74）,the recurrence, rate being 18. 9% （P〈0. 01）. Of the 45 patients who didn＇t undergo cholecysteetomy in non-EST group, 12 patients had recurrent gallstone pancreatitis （12/ 45）, the recurrence rate being 26.7%; of the 29 cases who underwent choleeystectomy, 2 had recurrent gallstone pancreatitis（2/29）, the recurrence rate was 6.9% （P〈 0.05）. The duration from patients＇ discharge to recurrence ranged from 2 weeks to 2 years. In the 2 patients who had undergone cholecystectomy, ERCP and EST and developed common bile duct calculi, no symptoms of pancreatitis appeared after EST. Conclusions EST is an effective alternative for preventing recurrence of gallstone pancreatitis, and is suitable for high-risk aged patients because of its minimal invasiveness. Cholecystectomy can reduce the recurrence rate of gallstone pancreatitis. Common bile duct calculi are the major cause of recurrent gallstone panereatitis.