急性胆源性胰腺炎52例临床分析

Clinical analysis of 52 cases with acute biliary pancreatitis

目的探讨急性胆源性胰腺炎(ABP)的治疗方法。方法回顾性分析我院近年来收治的52例ABP患者的临床资料,对ABP的各种治疗方法与疗效进行分析。结果 52例患者均治愈。根据有无胆管梗阻和ABP的轻重程度分别采取保守治疗、治疗性ERCP、内镜下胰管支架引流术、腹腔镜以及开腹手术的治疗方法。所有患者均首先采取保守治疗。对于有显著胆道梗阻的重症ABP患者采用治疗性ERCP的方法;ERCP失败的5例患者实施经内镜下胰管支架植入术,临床效果明显。除仅有1例患者因重症胰腺炎伴胰腺坏死伴感染而行手术治疗之外,其他所有患者的胆道病变均在胰腺炎治愈后1个月行外科处理。结论 ABP治疗以保守治疗为主,对于部分伴胆道梗阻的病例可以采用治疗性ERCP和胰管内支架引流的方法。总之,ABP的治疗需要对具体的情况采取个体化的治疗方案。

Objective To explore the treatment of acute biliary pancreatitis （ABP）. Methods The data of 52 patients with ABP were analyzed retrospectively, various curative methods and curative effects were analyzed. Results 52 patients all were recovered. According to obstruction or unobstruction of biliary tract and severity of ABP, conservative treatment, therapeutic ERCP, endoscopic pancreatic duct stent drainage, laparoscopy and laparotomy were selected separately, conservative treatment were adopted for all patients firstly. Severe ABP （SABP） with marked biliary tract obstruction selected therapeutic ERCP, 5 cases with failed ERCP performed endoscopic pancreatic duct stenting,and achieved significant curative effects.Except only one patient underwent laparotomy due to SABP with pancreatic necrosis and infection, all patients received surgical treatment of biliary tract disease after a month when patient with ABP recovered. Conclusion Conservative treatment is the main therapy of ABP. Therapeutic ERCP and pancreatic duct stent drainage can be selected for partial cases with biliary tract obstruction. The treatment of ABP should be individualized for special situation.