急性复发性胰腺炎128例的临床及影像学分析

Clinical research of acute recurrent pancreatitis.

目的研究AP复发的基本病因、临床表现及影像学特点。方法回顾性分析128例AP复发病例（复发组）及87例初发患者（对照组）的基本病因、临床表现,以及B超、CT和ERCP检查的影像特征。结果复发组患者有慢性胆囊炎病史者占46.1%;胆囊切除术后者占21.9%;胆囊结石者占28.1%;有高脂血症者占24.2%。均较对照组显著升高。作为发作诱因,油腻饮食者在复发组占32%,较对照组显著升高。复发组发生呕吐者38.3%、黄疸29.7%,较对照组显著升高。复发组血淀粉酶为（726.7±247.5）U/L,血总胆红素为（45.7±18.4）μmol/L,血ALT为（81.3±37.5）U/L、AST为（68.9±25.4）U/L、AKP为（146.3±81.2）U/L,与对照组相比均有显著差异。影像学检查,复发组胰腺回声粗强者达35.9%,胰管扩张者达17.9%,均显著高于对照组;胆囊炎症、结石和胆总管扩张的发生率也显著高于对照组;主胰管结石、扩张、狭窄及乳头部病变发生率在复发组也明显增多。另外复发组中有部分患者为胰腺分裂和胰胆汇流异常。结论胆囊炎、胆囊结石、胆总管结石等疾病可能是AP复发的主要病因,其他病因还有CP的急性发作。

Objective To analyze the characteristics of etiology, clinical features and imaging changes of acute recurrent pancreatitis. Methods The medical records of 128 patients with acute recurrent pancreatitis （recurrence group） and 87 patients with first attack acute pancreatitis （control group） were analyzed retrospectively, and the results of BUS, CT, ERCP were reviewed as well. Results In the recurrent group, the incidence of chronic cholecystitis was 46. 1% the incidence of history of cholecystectomy was 21. 9%; the incidence of cholecystolithiasis was 28. 1%; the incidence of hyperlipemia was 24.2%; all of these parameters were significantly higher than those in control group. The incidence of greasy food as the remote cause was 32%, which was significantly higher than that in control group. In recurrent group, the incidence of vomiting was 38.3%, jaundice was 29. 7%, which were significantly higher than those in control group. In recurrent group the serum amylase level was （726.7 ±247.5）U/L, total bilirubin was （45.7 ± 18.4）btmol/L, ALT was （81.3 ±37. 5）U/L, AST was （68.9 ±25.4）U/L, AST Was （68.9 ±25.4）U/L, AKP was （146.3 ±81.2）U/L, all of these were significantly higher than those of control group. In recurrent group, BUS and CT indicated that the incidence of pancreatic echo thickening was 35. 9%, with distention of pancreatic duct was 17. 9%, which were all significantly higher than those in control group; the incidence of cholecystitis, stone, choledochectasia were also significantly higher than those in control group. In recurrent group, ERCP findings indicated that the incidence of CDS and choledochectasia were 27.9% and 29.5 %, which were significantly higher than those in control group（P 〈 0.01） . in recurrent group the incidence of stone, distention, stenosis of main pancreatic duct and papilla disease were significantly higher than control group. In addition, in recurrent group some patients had pancreas divisum and abnormal pancreatico- biliary junction. Conclusions For acute recurrent pancreatitis, the incidence of co-morbidities of cholecystitis, cholecystolithiasis, choledocholithiasis,choledochus dilation were much higher than those in first attack acute pancreatitis, pancreatic and biliary diseases may be the main cause of acute recurrent pancreatitis, and some patients with recurrent pancreatitis had the medical history of chronic pancreatltis.