急性胰腺炎早期ERCP及内镜治疗66例

Early ERCP and endoscopic treatment in 66 patients with acute pancreatitis

目的探讨急性胰腺炎患者早期ＥＲＣＰ及内镜治疗应用的价值及安全性．方法急性胰腺炎患者作早期（１ｄ～７ｄ内）ＥＲＣＰ及内镜治疗（ＥＲＣＰ组，６６例），并以同期保守治疗的急性胰腺炎患者６０例作对照（对照组），观察两组患者血清淀粉酶恢复时间，腹痛缓解时间、住院天数、住院费用及并发症发生情况．结果ＥＲＣＰ组中，３６例为胆道疾病患者，４例为胰管结石，４例为胰腺分裂症，３例为乳头旁巨大憩室，１７例ＥＲＣＰ未见异常．作内镜下治疗３３例，其中ＥＰＴ及取石术１７例，４例作了副乳头切开及扩张术，１２例作了鼻胆管引流术．ＥＲＣＰ组腹痛缓解天数及平均住院天数分别为１１５ｄ±３６ｄ及２１７ｄ±５０ｄ，明显短于对照组（１５４ｄ±７８ｄ及３３０ｄ±６８ｄ，Ｐ＜００１）．血清淀粉酶恢复时间及住院费用两组相差不显著．两组均未发生严重并发症．结论急性胰腺炎早期ＥＲＣＰ及内镜治疗经济安全、有效，可缩短腹痛缓解时间及住院天数，作者认为对胆源性胰腺炎应尽早行ＥＲＣＰ及内镜治疗．

IM To study the value and safety of early endoscopic retrograde cholangiopancreatography (ERCP) in acute pancreatitis.METHODS Sixtysix patients with acute pancreatitis underwent early ERCP (within 1-7 days) and received endoscopic therapy (early ERCP group). Another 60 patients with acute pancreatitis were treated conservatively without ERCP (control group). The disappearance of abdominal pain, decrease of serum amylase level, the mean days and costs of hospitalization and complications were observed in all patients.RESULTS In ERCP group, there were 34 cases of biliary tract disease, 4 of pancreatic stones, 4 of pancreatic divisum, 3 of larger diverticula around the papilla, and 17 were normal. Thirtythree patients with biliary tract disease were treated by endoscopy, including papillosphincterotamy, endoscopic nasal biliary drainage and endoscopic dilatation of the accessory papilla, with no complications. There were no significant differences in the decrease of serum amylase levels and the cost of the hospitalization between early ERCP group and control group, but the days of the disappearance of abdominal pain and the hospitalization were significantly shorter in the early ERCP group than in the control group (P<001).CONCLUSION Early ERCP and endoscopic therapy is safe and more effective in patients with acute pancreatitis, especially in acute severe biliary pancreatitis.