内镜下十二指肠乳头括约肌切开术对急性胆源性胰腺炎的治疗价值

Treatment value of endoscopic sphincterotomy for acute biliary pancreatitis

目的探讨急性胆源性胰腺炎早期内镜治疗的价值及其安全性。方法选择82例急性胆源性胰腺炎患者早期(72h内)行逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)及内镜下十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)(ERCP组),并与同期保守治疗36例(对照组)进行比较。结果ERCP组全部成功实施EST,66例胆总管结石者行网篮及气囊取石,所有82例均行鼻胆管引流,重症组8例同时行胰管支架引流。ERCP组平均腹痛消失时间、血清淀粉酶恢复时间、平均住院天数及平均费用均明显低于对照组。ERCP组重症组死亡率8.33%,对照组重症组死亡率33.33%。结论急性胆源性胰腺炎早期ERCP治疗是安全的,能降低病人的死亡率,减少病人住院天数和费用。

[Objective] To study the value and safety of early endoscopic retrograde cholangiopancreatography （ERCP）and endoscopic sphincterotomy （EST） in acute biliary pancreatitls. [Methods] Ninty-two patients with acute biliary pancreatitis underwent early ERCP （within 72 hours） and received endoscopic therapy （ERCP group）. Another 36 patients with acute biliary pancreatitis were treated conservatively without ERCP （control group）. The disappearance of abdominal pain, decrease of serum amylase level, the mean days and costs of hospitalization and com- plications were observed in all patients. [Results] In ERCP group, all patients were performed EST, 66 cases of choledoeholithiasis had removed biliary stones with net-basket or air peeket. 8 cases of severe acute biliary pancreatitis were performed endoscopic pancreatic duct stents drainage. 82 cases of acute hiliary pancreatitis were performed endoscopic nose bile drainage. The days of the disappearance of abdominal pain, the decrease of serum amylase levels, the cost of the hospitalization and the days of the hospitalization were significantly shorter in the early ERCP group than in the control group. [Conclusion] Early ERCP and endoscopic therapy is safe and more effective in patients with acute biliary pancreatitis.