逆行胆胰管造影对急性胰腺炎的疗效和转归的影响

Eff icacy of ERCP in the management of acute pancreatitis

目的:探讨逆行胆胰管造影(ERCP)对不同病因引起的急性胰腺炎(AP)治疗效果,进一步把握ERCP的适应证.方法:对山西医科大学第二医院收治的114例AP病例按照不同病因分为2组,分别为胆源性胰腺炎(ABP)和非胆源性胰腺炎.每组分为保守治疗(对照组)和ERCP治疗(治疗组)两部分,比较2组重症胰腺炎(SAP)发生率的差异,以及不同疗法对AP的腹痛缓解时间、淀粉酶正常时间、住院时间的影响.结果:全组114例患者,保守治疗55例,ERCP治疗59例,保守治疗组重症化发生率为27%(15/55),ERCP治疗组重症化发生率为12%(7/59),两组比较重症化发生率有统计学差异(P<0.05);其中ABP对照组和治疗组重症化发生率分别为30%(8/24)和10%(3/30),有统计学差异(P<0.05),治疗组患者腹痛缓解时间和住院时间有统计学差异(P<0.05),治疗组时间较短;非胆源性胰腺炎对照组和治疗组重症化发生率分别为23%(7/31)和14%(4/29),无统计学差异;治疗组患者淀粉酶正常时间(6.92d±2.26d)和住院时间(8.1d±3.04d)较对照组淀粉酶正常时间(8.85d±3.08d)和住院时间(10.3d±3.80d)短,有统计学差异(P<0.05).结论:ERCP对ABP有积极的治疗作用,可以减少轻型胰腺炎(MAP)向SAP转化,减少SAP的发生率,对非胆源性胰腺炎也有治疗作用,缩短住院时间.

AIM： To investigate the efficacy of endoscopic retrograde cholangiopancreatography （ERCP） in the management of acute pancreatitis of various causes and to analyze the indications for ERCP.METHODS： One hundred and fourteen cases of acute pancreafifis were divided into two groups： acute biliary pancreatitis and non-biliary pancreatitis. Each group was further divided into two subgroups： one was treated by conservative method, and the other by ERCP. The incidence of severe acute pancreatitis, the time required to relieve abdominal pain and achieve normal amylase level, and the length of hospital stay were compared between different groups and subgroups. RESULTS： Of 114 cases of acute pancreatitis, 55 received conservative treatment, and 59 received ERCP. The incidence of severe acute pancreatitis was significantly higher in the conservative group than in the ERCP group （27% vs 12%, P 〈 0.05）. In the acute biliary pancreatitis group, the incidence of severe acute pancreatitis was significantly higher in the conservative subgroup than in the ERCP subgroup （30% vs 10%, P 〈 0.05）, and the time required to relieve abdominal pain and the length of hospital stay in the ERCP subgroup were significantly shorter than those in the conservative subgroup （both P 〈 0.05）. In the non-biliary pancreatitis group, the incidence of severe acute pancreatitis was comparable between the conservative subgroup and ERCP subgroup （23% vs 14%, P 〉 0.05）, but the time required to achieve normal amylase level （6.92 d ± 2.26 d vs 8.85 d ± 3.08 d, P 〈 0.05） and the length of hospital stay （8.1 d ± 3.04 d vs 10.3 d ± 3.80 d, P 〈 0.05） in the ERCP subgroup were shorter than those in the conservative subgroup.CONCLUSION： ERCP is effective in the management of acute pancreatitis and can effectively prevent the progression from mild acute pancreatitis to severe acute pancreatitis. ERCP is also effective in the management of non-biliary pancreatitis in terms of shortening the length of hospital stay.