内镜联合药物治疗急性重症胰腺炎153例临床分析

The clinical effect of emergency endoscopic therapy on the patients with severe acute pancreatitis

目的探讨内镜介入治疗急性重症胰腺炎(SAP)的临床价值。方法2001年2月至2006年2月将四川大学华西医院收治的SAP患者289例,随机分为对照组(136例)和内镜治疗组(153例)。对照组采用内科药物治疗;内镜治疗组在与对照组相同治疗的基础上行十二指肠乳头括约肌切开(EST)、取石、鼻胆管引流(ENBD)或鼻胰管引流术(ENPD)。比较两组患者腹痛、腹胀缓解时间,血清淀粉酶恢复正常时间,入院3d和6d的APACHEⅡ评分指标,平均住院天数、住院费用等。结果内镜治疗组腹痛、腹胀缓解所需天数[(10.5±3.0)d]明显低于对照组[(12.4±6.8)d,P<0.05]。与对照组相比,内镜治疗组血清淀粉酶恢复正常水平所需时间较短(P<0.05),APACHEⅡ评分值也较对照组下降快,平均住院日和治疗总费用均显著低于对照组(P均<0.05)。结论无论是胆源性SAP还是非胆源性SAP,在常规药物治疗的基础上,于起病后72h内实施EST+ENBD或ENPD,可获得更好的治疗效果。

Objective To study the clinical effect of endoscopic therapy in the patients with severe acute pancreatitis （SAP）. Methods Totally 289 patients with SAP were divided into endoscopic therapy and control groups in random. The patients in control group received conventional medications. The patients in endoscopic group not only received conventional medications but also took endoscopic sphincterotomy （EST）, removing stones, endoscopic nasobile or nasopancreatic drainage within 72 h after onset. The remission time of abdominal pain and distention, the duration of serum amylase back to normal, APACHE Ⅱ scores, hospitalization days and expenditure were compared between two groups. Results The remission time [ （10. 5 ± 3. 0） day] of abdominal pain and distention in endoscopic group was significantly lower than that [ （ 12. 4±6. 8） day] of control group,P 〈0. 05. Compared with control group,the duration of serum amylase back to normal in endoscopic group was notably shorter, （9. 5 ± 2.0） day vs （8. 3 ±3. 2 ） day, P 〈 0. 05. APACHE Ⅱ scores in endoscopic group decreased faster than that in control. Both hospitalization days and expenditure in endoscopic group were less than that of control. Conclusion Performance of EST ＋ ENBD or ENPD within 72 h for patients with either gallstone s, or non gallstone SAP greatly improves the clinical result with better cost-effect.