急性胆源性胰腺炎早期内镜治疗的疗效评价

Therapeutic evaluation of early endoscopic therapy for patients with acute biliary pancreatitis

目的观察内镜治疗急性胆源性胰腺炎（ABP）的疗效及其并发症。方法急性胆源性胰腺炎70例，其中37例于24h内行逆行胰胆管造影术（ERCP）、内镜下乳头括约肌切开（EST）后用网篮取石或碎石网篮碎石后气囊取石术及内镜下鼻胆管引流术（内镜组）；另33例行保守或急诊外科手术治疗（对照组）。结果内镜组治疗的成功率为92％，未发生与内镜操作有关的严重并发症；与对照组比较，内镜组术后腹痛缓解时间、住院时间明显缩短（P〈0．01），术后第1天血及尿淀粉酶无明显差异（P〉0，05），但术后第2天血及尿淀粉酶明显降低（P〈0．05），第3天降低更为明显（P〈0．01）。结论急性胆源性胰腺炎早期ERCP及内镜治疗安全有效，是治疗急性胆源性胰腺炎的理想方法。

Objective To observe the therapeutic effects and complication of combined endoscopic trerapy of the acute biliary pancreatitis（ABp）. Methods 70 cases of acute biliary pancreatitis were treated in our hospital in recent 7 years. 37 cases（group E） admitted undergone emergency endoscope procedure were treated with endoscopi- cretrograde cholongiopancreatography （ ERCP ）, endpscopic sphincterotomy （ EST ） and endoscope naso-biliary drainage（ENBD） in 24h after be hospitalized. 33 cases（group C） were treated with conservation treatment or operation treatment. Results Achievement ratio of endoscopic management was 92 %. There was no severe complication or mortality in group E. The duration of symptoms and hospitalization in endoscopy group were significantly shorter than those in group C（P （ 0.01 ）. The change of serum and urine amylase was not significant between two groups in the first day after treatment（P 〉 0.05）. But the serum and urine amylase of group E were significantly lower than those in group C in the second day（P 〈0.05） and more significantly lower in the third day after treatment（ P 〈0.01 ）. Conclusion Early endoscopic therapy is safe and effective in At3P patients. It is a valuable method to treat acute biliary pancreatitis.