胰管支架在内镜治疗困难的急性胆源性胰腺炎中的应用

Pancreatic duct stenting for acute biliary pancreatitis with difficult endoscopic cannulatio

目的探讨胰管支架在内镜治疗困难的急性胆源性胰腺炎中的临床应用价值。方法选择2005年1月至2009年12月间入院行内镜治疗急性胆源性胰腺炎困难患者81例，随机分为胰管支架治疗组35例，而未放置胰管支架的46例患者作为对照组，术后2组使用相同药物治疗，病情平稳后取出胰管支架（平均11d），出院后随访3个月。结果2组术前平均年龄、发病至接受内镜时间、Glasgow评分及相关生化指标等差异无统计学意义，但胰管支架组术后并发症发生率与对照组差异有统计学意义（5．71％和17．39％，P〈0．01）。结论在内镜治疗急性胆源性胰腺炎困难时使用胰管支架是安全的，能降低患者的并发症，为治疗急性胆源性胰腺炎的一种过渡性方法，具有一定的临床应用价值。

Objective To evaluate pancreatic duct stenting for acute biliary pancreatitis with difficult endoscopic cannulation. Methods From January 2005 to December 2009, in patients with acute biliary pancreatitis who needed intervention of emergency ERCP, a total of 81 cases were found to be with difficult cannulation and were randomly divided into either treatment group （ n = 35 ） to receive pancreatic duct stenting, or control group （ n = 46 ） to receive the procedure without pancreatic duct stenting. All patients were treated with same medication, and the pancreatic stents were removed after stabilization at a mean time of 11 days after ERCP. All patients were followed up for 3 months after discharging from the hospital. Results There was no significant difference between two groups in regarding of mean age, the time from onset to endoscopy, Glasgow scores and relevant biochemical parameters, but the occurrence of postoperative complications was significantly higher in control group than that of the treatment group （ 17. 39% vs. 5. 71%, P 〈 0. 01 ）. Conclusion Pancreatic duct stenting is a safe and bridging procedure for patients with acute billiary pancreatitis, which can also reduce complications.