急性胆源性胰腺炎41例诊治体会

The Diagnosis and Treatment of 41 Patients with Acute Biliary Pancreatitis

目的探讨急性胆源性胰腺炎(ABP)的最佳治疗方案及效果.方法回顾分析41例急性胆源性胰腺炎的临床资料,总结ABP的诊治方式和治疗效果.结果总病例41例,轻症非梗阻型25例,早期非手术治疗效果良好,其中22例伴慢性胆囊炎病史患者缓解4周后行腹腔镜胆囊切除术治愈,3例因影像检查无明显阳性,胰腺炎治愈后出院,随访无复发;轻症梗阻型5例在非手术治疗缓解4周后行ERCP+EST术;重症非梗阻型2例因伴胆囊颈部结石嵌顿入院24h行急诊手术;重症梗阻型9例,其中7例胆总管直径>1.0cm者,入院12～24h内急诊行开腹胆道探查和胰腺坏死组织清除术,另2例非手术治疗无效于48h内急诊内镜治疗.41例患者均无严重并发症,治愈出院.结论轻型非梗阻型ABP早期非手术治疗多可获得缓解,故早期应尽量保守治疗;轻型梗阻型早期可试行非手术治疗,而重症梗阻型应尽早行手术或内镜解除胆道梗阻.

Objective To investigate the best treatment and effect of acute biliary pancreatitis（ABP）.Methods The clinical data collected from 41 cases with acute biliary pancreatitis in our hospital were reviewed,the diagnosis and treatment method were summarized.Results A total of 41 cases,in which the cases number of the mild non-obstructive type were 25,non-surgical treatment had a good results in early phase.22 cases of patients with chronic cholecystitis underwent laparoscopic cholecystectomy 4 weeks later since pancreatitis recovered.3 cases had no significant positive results by imaging,and discharged after pancreatitis were cured,without recurrence by follow-up survey.5 cases of mild obstructive type accepted non-surgical treatment in early phase,underwent endoscopic retrograde cholangiopancreatography（ERCP） ＋endoscopic sphincterotomy（EST） 4 weeks later.2 cases ofsevere non-obstructive type with gallbladder neck calculi accepted emergeny operation within 24 h.9 cases of severe obstructive type,in which 7 cases with common bile duct diameter 〉1.0 cm underwent emergeny operation to explore by choledochostomy and to remove necrotic tissue of pancreatic within 12～24 h,another 2 cases accepted emergency endoscopic treatment within 48 h as non-surgical treatment were ineffective.A total of 41 cases had no serious complications.Conclusion The non-obstructive type of ABP can be alleviated by non-surgical treatment as usual,so treatment should be conservative in early phase.Also non-surgical treatment can be tried to the mild obstructive type in early phase,and for the severe obstructive typewe＇d better do surgery or endoscopic to relieve biliary obstruction as soon as possible.