内镜早期治疗43例胆源性胰腺炎的临床研究

Clinical Research of Pristine Therapia with Endoscope on Acute Biliogenic Pancreatitis

目的评估内镜早期治疗对胆总管下段结石引起的胆源性胰腺炎(ABP)的临床效果及安全性。方法 86例胆总管下段结石引起ABP患者随机分为内镜治疗组及对照组,两组患者入院后均采用抗酶、抑酸、抗感染及营养支持等方法治疗,内镜组患者在入院诊断明确后即行经内镜胰胆管造影取石术,取出胆总管下段结石,比较72h后两组患者临床治疗效果、影像学评级差异及血清淀粉酶、IL-6、TNF-α水平差异。结果 治疗72h后,对照组患者有效率为67.4%,内镜组患者有效率为86.0%,内镜组患者有效率高于对照组。内镜组患者血清淀粉酶、IL-6、TNF-α水平低于对照组,CT影像学分级评分低于对照组。结论 胆总管下段结石引起的ABP早期采用内镜治疗,能够缓解胰腺的持续损伤,减少炎性介质的持续释放,改善患者临床治疗效果,具有较好的临床疗效。

Objective To evaluate the clinical and safety of pristine endoscope therapia on acute biliogenic pancreatitis （ABP） that were induced with inferior extremitycommon duct stones. Methods 86 cases of patients with acute biliogenic pancreatitis （ABP） that were induced with inferior extremitycommon duct stones were selected and randomly divided into endoscope groups and control groups, all patient taken normative treatment with depressing gastric acid and protease,anti-infection and nutritional support,patients in endoscope groups received endoscope therapia and duct stones was dislodge with endoscopic retrograde cholangio pancreatography sphincterotomy andlithotomy after final diagnosis. After 72h,clinical effect and grading in imageology were contrasted between control groups and endoscope groups,level of hemodiastase,interleukin-6（IL-6） and tumor necrosis factor-α （TNF-α） were compared between control groups and endoscope groups. Results After 72h,clinical effective power was 67.4% in control groups and was 86.0% in endoscope groups,clinical effective power was higher in endoscope groups than in control groups,level of hemodiastase,IL-6 and TNF-α were lower in endoscope groups than in control groups,grading in imageology was lower in endoscope groups than in control groups. Con- clusion Pristine endoscope therapia on ABPthat were induced with inferior extremitycommo could release durative injury of pancreas, decrease releasing of mediators of inflammation, improve clinical therapeutic efficacy and had good clinical effect.