180例急性胆源性胰腺炎早期内镜治疗与保守治疗的临床分析

Clinical analysis of early endoscopic therapy and conservative treatment for acute biliary pancreatitis in 180 cases

目的通过观察经过早期内镜治疗或者保守治疗的急性胆源性胰腺炎患者临床情况,分析急性胆源性胰腺炎的非外科手术治疗的最佳方案。方法将180例急性胆源性胰腺炎患者分为重症急性胆源性胰腺炎患者组(86例)和轻症急性胆源性胰腺炎患者组(94例),以上两组均随机分成两组,分别予以早期内镜治疗组和保守治疗,对比观察4组患者治疗后症状缓解天数、血清淀粉酶恢复时间、并发症发生率、死亡率及住院天数等指标。结果与重型保守治疗组相比,重型内镜治疗组白细胞、血淀粉酶、尿淀粉酶、肝功能、腹痛恢复时间及住院时间明显缩短,并发症率降低(P<0.05);而轻症内镜治疗组与轻症保守治疗的观察指标比较没有统计学意义(P>0.05)。结论重型急性胆源性胰腺炎应早期行内镜治疗,而轻型急性胆源性胰腺炎按照具体病情可以选择内科保守治疗或者内镜治疗,采取个体化的治疗原则。

Objective To observe the therapeutic effects of early endoscopic treatment and conservative treatment on acute biliary pancreatitis（ABP） and to seek for the best non-surgical treatment.Methods A total of 180 patients with ABP were divided into two groups： severe acute biliary pancreatitis group（SABP）（n=86） and mild acute biliary pancreatitis group（MABP）（n=94）.SABP group and MABP group were subdivided into two groups according to the treatment methods.Endoscopic therapy and conservative treatment were provided to the four groups respectively.The symptoms,laboratory indexes,complication and death rates as well as duration were comparatively analyzed between the four groups.Results The recovery time of white blood cell,hemodlastase,amylase in urine,liver function and abdominal pain as well as hospital duration were shortened in SABP endoscopic treatment group compared with those in SABP conservative treatment group（P0.05）.However,there were no statistical significance in the clinical observation index between MABP endoscopic treatment group and MABP conservative treatment group（P0.05）.Conclusion For patients with SABP,early endoscopic treatment（within 24 hours after admission） is safer and more effective,but for patients with MABP,both conservative treatment and endoscopic treatment can be adopted according to the condition.