急性胆源性胰腺炎的治疗选择

Management of patients with acute billiary pancreatitis

目的探讨急性胆源性胰腺炎合并持续性胆总管结石的预测指标和治疗选择。方法回顾分析广州医学院第三附属医院近10年内治疗134例急性胆源性胰腺炎的临床资料。结果134例急性胆源性胰腺炎病例中，30例经胆道造影或胆总管探查确诊胆总管结石阳性。多因素分析显示，人院时B超下胆总管直径（common bile duct，CBD size）、碱性磷酸酶（ALP）、总胆红素（TB）与胆总管结石显著相关。应用ROC曲线获得诊断胆总管结石的最佳预测值为：CBDsize≥10mm；ALP≥150U／L；TBI〉51．3μmol／L。结论3项预测指标均为阳性时诊断胆总管持续性结石具有统计学意义，建议行ERCP／EST或术中胆总管探查。各项诊断指标均为阴性时，建议行保守治疗，住院期间行胆囊切除术。当仅含有1、2项预测指标阳性时，需根据病例具体情况作相应胆道评估或治疗。

Objective To investigate the treatment options of acute biliary pancreatitis. Methods A retrospective review was performed in 134 consecutive patients who presented to a single tertiary care institution from 2000 to 2010 with acute biliary pancreatitis. Results Of the 134 patients, 30 had a persistent （commonbile duet, CBD） stone. Following multivariate analysis, at admission CBD size on ultrasound,alkaline phosphatase （ALP）, total bilirubin （TB）, significantly correlated with persistent CBD stone. Receiver operator curve analysis and linear regression were applied to obtain optimal and equitable predictive values, and variables combined. Optimal values were ： CBD ≥ 10 mm; AP ≥ 150 U/L; and TB ≥51.3 μmol/ L. Presence of three variables had an associated odds ratio （OR） of 29.5 （ P 〈 0.001 ） for presence of persistent CBD stone. Zero variables conferred asignificantly deereaaed probability of CBD stone, OR 0. 07 （P 〈0. 001 ）. Conclusions Presence of three variables significantly correlated with persistent CBD stone. Bili- ary evaluation by endoscopic retrograde cholangiopancreatography （ERCP） is suggested. In the absence of any positive predictive variables, cholecystectomy may be sufficient. Decisions regarding patients with one to two be made variables should occur on a case-to-case basis.