急性胆源性胰腺炎的早期内镜干预

Early management of acute biliary pancreatitis with duodenoscopy

目的评价急性胆源性胰腺炎(ABP)早期内镜治疗的价值。方法ABP患者69例中,早期十二指肠镜治疗41例(D组),48h内行逆行胰胆管造影术、内镜下乳头括约肌切开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;另外28例(C组)采用常规治疗。结果D组术后腹痛缓解快,24h血及尿淀粉酶开始降低,治疗的成功率为100%,未发生与内镜操作有关的严重并发症,住院时间比C组短(P<0.01)。结论内镜治疗能及时解除胆胰管开口的梗阻,通畅胆胰液的引流,微创、安全、有效,是治疗ABP的有效方法。

Objective To evaluate the therapeutic effect of early management of acute biliary pancreatitis （ABP） with duodenoscopy. Methods Of 69 ABP cases, 41 patients（group D） received endoscopic retrograde cholongiopancreatography, sphincterotomy plus endoscopic lithotomy and endoscope naso-biliary drainage. Other 28 cases（group C） were treated with conventional therapy. Results All patients in group D were successfully treated with duodenoscopy in attenuating abdominal pain and reducing serum and urine amylase levels without severe complications related to the endoscopy. The hospital stay in group D was significantly shorter than that in group C （P〈 0. 01）. Conclusion Early management of ABP with duodenoscopy may effectively relieve the orifice obstruction of cholecystopancreatic duct, decrease the pressure of intra- cholecystopancreatic duct with mini-invasion.