急性胰腺炎复发诱因及内镜治疗

The etiology and endoscopic management of acute recurrent pancreatitis

目的 探讨急性胰腺炎（AP）复发的诱因及其内镜治疗效果.方法 杏阅2002年1月至2008年12月长海医院收治的AP患者.详细记录患者临床资料;是否行内镜逆行胰胆管造影术（ERCP）治疗、治疗方法及并发症.电话随访后根据是否AP复发将患者分为无复发组与复发组.分析两组致病因素及内镜治疗疗效.结果 804患者入组,其中无复发组512例（63.68%）,复发组292例（36.32%）.无复发组平均年龄52岁,复发组平均年龄44岁,相差显著（P〈0.01）.201例重症胰腺炎中,无复发组104例（20.31%）,复发组97例（33.22%）,复发组显著高于无复发组（P〈0.01）.无复发组并发胰腺假性囊肿46例,复发组44例,两组胰腺假性囊肿发生率差异显著（P〈0.05）.AP病因为胆源性、高三酰甘油血症是胰腺炎反复发作的危险因素.139例复发性AP患者行ERCP治疗,15例（5.15%）并发ERCP术后胰腺炎,1例（0.34%）出现十二指肠乳头切开后出血.成功随访内镜介入治疗的118例复发性AP患者,内镜治疗总缓解率为78.8%.结论 复发组发病年龄较小,重症急性胰腺炎发生率及胰腺假性囊肿发生率均高,胆源性及高三酰甘油血症为诱发AP复发的危险因素.内镜介入治疗对复发性AP同样有效.

Objective To investigate the etiology and the efficacy of endoscopic management of acute recurrent pancreatitis. Methods Patients with acute pancreatitis （AP） who were admitted in Changhai Hospital from January 2002 to December 2008 were included in the study population. The medical records were reviewed; the ERCP procedures and other treatment options and complications were documented. After the follow-up the patients were divided into two groups： single attack group （SAG） and recurrent attack group （RAG）. The etiology and the efficacy of endoscopic management were analyzed. Results 804 patients were included, 512 patients（63.68%） had AP attacked once, 292（36.32%） had AP recurrent attack . The SAG had a mean age of 52 years old; the RAG had a mean age of 44 years old, the age difference between the two groups had statistical significance （P〈0.01）. In 201 patients with severe AP, 104（20.31%） patients had AP attacked once, 97 （33.22%） had AP recurrently attacked , the difference between the two groups was statistically significant （P 〈 0.01）. There were 46 cases in SAG complicated with pancreatic pseudocysts, and 44 cases in RAG complicated with pancreatic pseudocysts, the incidence between the two groups was statistically significant （P 〈 0.05）. Biliary origin, hypertriglyceridemia were risk factors for recurrent AP. 139 patients with recurrent AP underwent ERCP, and 15 patients developed post-ERCP pancreatitis, 1 patient developed post-endoscopic sphincterotormy bleeding. Follow-up of 118 recurrent AP patients showed the overall remission rate of endoscopic treatment was 78.8%. Conclusions The patients in RAG were younger than those in SAG. The incidence of severe AP and pancreatic pseudocyst was higher in RAG. Cholelithiasis and hypertriglyceridemia were high risk factors of recurrent AP. Endoscopic management was an effective treatment for recurrent AP.