疼痛性慢性胰腺炎的内镜介入疗效

Endoscopic managements in pain of chronic pancreatitis

目的探讨内镜介入治疗疼痛性慢性胰腺炎的疗效。方法以2002年亚太共识报告中提出的共识意见为慢性胰腺炎诊断标准，回顾分析1997年至2006年间经内镜介入治疗疼痛性慢性胰腺炎患者的临床资料，评价其治疗的疗效。结果成功随访214例（84．6％），其中男女性别比约2．1：1，年龄6．5～78．0岁，平均40．5岁，随访12～131个月，平均41．9个月。28例（13．1％）经内镜治疗后又行手术。患者经单一内镜治疗或再接受手术治疗后，腹痛缓解率分别为83．9％和71．4％（P〉0．05），总的内镜治疗后腹痛缓解率为73％。内镜治疗术后并发症71例次（14．9％），包括术后胰腺炎（12．6％）、轻度胆管炎（2．1％）和出血（0．2％），均经药物治疗2～20d后症状体征消失，无穿孔、死亡病例。结论内镜介入治疗是一种有效的治疗疼痛性慢性胰腺炎的方法。

Objective To determine the efficacy of therapeutic endoscopic retrograde cholangio-pancreatography （ERCP） in treatment of pain of chronic pancreatitis （CP）. Methods The data of CP patients accompanying with pain, who received therapeutic ERCP from 1997 to 2006, were retrospectively analyzed. The diagnosis of CP was made based on the criteria from 2002 Asia-Pacific Consensus, and the effect of therapy was evaluated. Results Of 253 patients who received therapeutic ERCP, follow-up data were obtained from 214 patients （ 144 males and 70 females, ages ranging from 6.5 to 78.0 years, mean age 40. 5 years）. The mean follow-up period was 41.9 months （ 12 - 131 months）. Twenty-eight patients （ 13.1% ） under- went surgery after ERCP. Relief rates of pain in patients who underwent ERCP with or without operation were 71.4% and 83.9% （P 〉 0. 05 ） respectively. The overall relief rate of ERCP was 73%. The incidence of major complications related to the procedure was 14. 9% （71/476） in terms of ERCP sessions, including post-ERCP pancreatitis in 12. 6% , mild cholangitis in 2. 1% and hemorrhage in 0. 2%. All complications sub- sided with conservative medical managements in 2 to 20 days. No perforation or death related to the procedure occurred. Conclusion Therapeutic ERCP is a mean of effective management of pain in patients with CP.