复发性急性胰腺炎临床特征及诊治分析84例

Rational diagnosis and therapy for recurrent acute pancreatitis: a clinical analysis of 84 cases

目的:探讨复发性急性胰腺炎(recurrent acute pancreatitis,RAP)的病因,临床、内镜、影像学表现及治疗.方法:回顾性分析我院2001-9/2007-12收治的84例RAP(复发组)及67例初发性急性胰腺炎(acute pancreatitis,AP)(对照组)患者的临床资料,包括临床表现、内镜、影像学特征、治疗及预后.结果:复发组中胆道疾患发病率显著高于对照组(60.7%vs38.8%,P<0.01).复发组中放射痛、黄疽、肠梗阻的发生率较对照组升高,但无统计学意义.复发组胰腺回声粗强者(38.3%)、胰管扩张者(21.3%),胆囊炎症、结石和胆总管的发生率也显著高于对照组;ERCP复发组发现胆总管结石、扩张者显著高于对照组(35.8%vs11.6%,32.1%vs9.3%,P<0.01或P<0.05).84例RAP患者中20例手术治疗,48例保守治疗,16例内镜治疗,其中手术治疗和保守治疗各死亡患者3例,内镜治疗无死亡.结论:RAP最常见病因为胆道疾患、饮食不当、酗酒;明确病因后积极治疗原发病因,可有效减少其复发;内镜下诊断和介入治疗是微创、疗效确切的手段,值得临床进一步推广.

AIM： To investigate the characteristics of etiology, clinical features and endoscopic manifestations and prevention methods of recurrent acute pancreatitis. METHODS： The clinical data of 84 patients with recurrent acute pancreatitis （recurrence group） and 67 patients with incipient acute pancreatitis （control group） at our hospital from September 2001 to December 2007 were retrospectively analyzed; the results of imaging changes and endoscopy therapy were reviewed as well. RESULTS： Incidence rate of biliary tract diseases was significantly higher in relapse group than in the control group （60.7% vs 38.8%, P 〈0.01）. Radiation pain, jaundice, intestinal obstruction were increased in the relapse group than in the control group, but there was no marked difference. Crude echo （38.3%）, pancreatic duct dilation （21.3%）, cholecystitis, the common bile duct stone were also significantly higher in relapse group than in control group. ERCP showed that stones and common bile duct dilation were significantly higher in relapse group than in control group （35.8% vs 11.6%, 32.1% vs 9.3%, P 〈 0.05）. Of 84 RAP cases, 20 underwent surgical treatment, 48 conservative treatment, and 16 endoscopy therapy. Three died in each surgery group and conservative treatment group, and none in endoscopy therapy group. CONCLUSION： Recurrent acute pancreatitis often results from biliary tract diseases including cholelithiasis, chronic cholecystitis, inappropriate eating habit and alcohol use. Rational diagnosis and therapy is important measure to prevent relapse. Endoscopy therapy for RAP is safe, minimally invasive and effective, and is recommended for wide use.