经内镜治疗急性胆源性胰腺炎的临床价值

Evaluation of endoscopic therapy in the treatment of acute biliary pancreatitis

目的探讨治疗性 ERCP 在急性胆源性胰腺炎(acute biliary pancreatitis,ABP)治疗及减少复发中的临床价值。方法将 ABP 患者依据其治疗方式,分为内镜组行 ERCP 治疗和对照组行常规治疗,比较其腹痛缓解时间及血、尿淀粉酶降至正常时间及肝功能恢复时间和住院天数。随访所有 ABP 患者,比较两组患者复发率。结果 117例 ABP 患者中急性轻症胆源性胰腺炎患者99例(84.6%),急性重症胆源性胰腺炎患者18例(15.4%)。内镜组和对照组总例数分别为49例和68例。内镜组与对照组比较,急性轻症胆源性胰腺炎和急性重症胆源性胰腺炎的腹痛缓解时间、肝功能恢复时间、住院天数均明显缩短(P<0.05或 P<0.01)。血、尿淀粉酶恢复时间两组比较差异无统计学意义。内镜组无明显内镜治疗相关并发症发生。所有患者平均随访时间20个月(5～37个月);7例失访,随访率94.0%。内镜组的复发率0(0/46)明显低于对照组46.8%(29/62)(P<0.01)。结论与常规治疗比较,ERCP 治疗 ABP 是较好方法之一,不仅疗效好、恢复较快,而且安全,并能减少胆源性胰腺炎的复发。

Objective To evaluate therapeutic ERCP in the treatment and preventing the recurrence of acute biliary pancreatitis（ABP）. Methods One hundred and seventeen patients of ABP were randomly divided into two groups, ERCP treatment group （ n = 49 ） and non-ERCP control group （ n = 68 ）. Changes of clinical symptoms and laboratory indexes were recorded accordingly. Follow-up study was for all the patients. Results Of the 117 with ABP, 99 cases were mild（MABP） and 18 ones were severe （SABP）. The days of relief of abdominal pains, normalization of hepatic function indexes and hospitalization were significantly shorter in ERCP treatment group than that in control group. The complications related to endoscopic therapy were not found. All patients had got followed-up visits for average 20（ range 5-37 ）months（94. 0% ）. The recurrence rate in the ERCP group 0（ 0/46 ） were significantly lower than that in the control group 46. 8% （ 29/ 62 ） （ P 〈 0. 01 ）. Conclusion Compared with conventional therapy, therapeutic ERCP is a safe and effective procedure in the treatment of ABP, and the procedure can also prevent its recurrence.