内镜结合中西医治疗急性胰腺炎的临床分析

Clinical analysis of endoscopy combined with traditional chinese and western medicine in treatment of acute pancreatitis

目的观察内镜结合中西医治疗急性胰腺炎的临床疗效。方法对确诊为急性胰腺炎的49例患者，在内科常规治疗的同时，于发病后1～3d行逆行胰胆管造影（ERCP），适时行十二指肠乳头肌切开或胆道取石术（EST）和鼻胆管引流（ENBD），并结合中药灌肠或口服的临床资料进行回顾性分析、总结。并与同期单纯给予内科常规治疗并结合中药灌肠或口服治疗的急性胰腺炎患者57例的疗效进行比较。结果49例急性胰腺炎患者中，行ERCP4-ENBD29例，ERCP-4-EST20例。ERCP插管成功率100％，诊断为胆总管结石46例，其中胆总管泥沙样结石26例，结石嵌顿3例，较大结石的4例，胰头癌3例。术后无一例出现出血、穿孔以及与操作有关的胰腺炎加重的情况。1例因胰腺脓肿转上级医院手术，1例因肺部重度感染而死亡，3例胰头癌合并急性胰腺炎好转后转肿瘤科，4例转外科择期行胆囊切除术，其余38例均好转出院，病程最长2—41d，平均7d。对6例复发的急性胰腺炎患者也有效，随访无复发。结论ERCP结合中西药治疗急性胰腺炎能迅速缓解临床症状，尚可缩短病程，减低重症胰腺炎转化危险，降低重症胰腺炎的病死率，对复发的急性胰腺炎也有效。

Objective To observe the clinical curative effect of combination of endoscopy, TCM and western medicine in treatment of acute pancreatitis. Methods Forty - nine cases of acute pancreati- tis, in addition to medical treatment, were given retrograde Cholangiopancreatography （ERCP）1 -3 days after the onset, timely open or biliary duct stones of papillary muscle of the duodenum （EST） and Naso- biliary drainage （ENBD）, and combined with oral administration of Enema with traditional chinese medi- cine. And with the same period of simple medicine general treatment combined with traditional chinese medicine enema or oral treatment of 57 cases of acute pancreatitis curative effect. Results Among the 49 patients with acute pancreatitis, 29 cases of ERCP ＋ ENBD, 20 cases of ERCP ＋ EST. ERCP cannu- lation success was 100% , 46 cases were diagnosed of bile duct stones, 26 cases of sediment samples of common bile duct stones, stone incarceration in 3 cases, 4 cases of large stones, 3 cases of carcinoma of head of pancreas. No bleeding, perforation, or operations - related pancreatitis of exacerbation of the sit- uation after operation. One case of pancreatic abscess turn to superior hospital for surgery, 1 case of death from severe infections of the lungs, 3 cases of pancreatic head carcinoma complicated with acute pancreatitis after radiotherapy, during surgical elective cholecystectomy in 4 cases, 38 cases turn for the better discharge, course up to 41 days, minimum of 2 days, 7 days on average. On 6 cases of recurrence of acute pancreatitis are also valid, follow - up of non - recurrent. Conclusions ERCP combined with western medicine in treatment of acute pancreatitis can quickly reduce clinical symptoms, can shorten the course, reduce the risk severe pancreatitis with transformation, reducing the mortality of severe pancreatitis, are also valid on the recurrence of acute pancreatitis.