摘要
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115d±36d及217d±50d,明显短于对照组(154d±78d及330d±68d,P<001).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 Sixtysix 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. Thirtythree 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<001).CONCLUSION Early ERCP and endoscopic therapy is safe and more effective in patients with acute pancreatitis, especially in acute severe biliary pancreatitis.
关键词
胰腺炎
治疗
胰胆管造影术
内窥镜逆行
pancreatitis/therapy
cholangiopancreatography, endoscopic retrograde
pancreatitis/diagnosis
acute disease