复发性急性胰腺炎病因分析及内镜治疗的价值

Clinical value of etiological analysis and endoscopic treatment of recurrent acute pancreatitis

目的探讨复发性急性胰腺炎(recurrent acute pancreatitis,RAP)的临床特点、病因及内镜治疗的临床价值,以提高对RAP的诊治水平。方法回顾性分析重庆医科大学附属第一医院2004年12月至2011年10月234例RAP住院患者的临床资料,将其分为内镜治疗组(内镜组)、手术治疗组(手术组)及药物保守治疗组(药物组),随访治疗效果,并对各组复发情况进行对比分析。结果 RAP的主要病因包括胆源性(39.7%,93/234),其次为代谢性(高脂血症,25.6%,60/234)、酒精性(19.7%,46/234)。234例RAP平均复发1.4次,距初次发作时间为2～96(22.5±18.8)个月,3年内复发193例,复发率82.5%。内镜组及手术组治疗后分别复发11例(13.4%)、4例(12.5%),同两者术前3年内复发情况比较[内镜组复发71例(86.6%);手术组复发26例(81.2%)]显著下降(P<0.01);药物组治疗后复发76例(63.3%)较治疗前3年内复发96例(80.0%)有所下降(P<0.05);内镜及手术治疗同药物保守治疗比较能显著降低RAP的复发(P<0.01)。结论胆源性、代谢性、酒精性因素是RAP的主要病因。内镜治疗能显著地减少RAP的复发,对RAP的治疗具有重大意义。

Objective To investigate the clinical features and pathogenic factors of recurrent acute pancreatitis（RAP） and the clinical value of endoscopic treatment for improving the diagnosis and treatment of RAP.Methods The clinical data of 234 RAP inpatients collected from the First Affiliated Hospital of Chongqing Medical University during Dec.2004 to Oct.2011 was analyzed retrospectively.The patients were divided into an endoscopic treatment group（endoscopic group）,a surgical treatment group（surgical group） and a medicine treatment group（medicine group）.The curative effect of each group was followed up,and a comparative analysis of recurrence among the three groups was performed.Result The main causes of RAP included biliary tract disease（93 cases,39.8%）,metabolic disease（60 cases,25.6%） and alcohol abuse（46 cases,19.6%）.In the 234 cases of RAP,the average recurrence frequency was 1.4 times.The recurrence interval from the initial onset was from 2 to 96 months with an average recurrence interval of（22.5±18.8） months.There were 193 recurrent cases within 3 years with a recurrence rate of 82.5%.The recurrence rates of the endoscopic group and the surgical group after treatment [11/82（13.4%） and 4/32（12.5%）] significantly decreased as compared with those [71/82（86.6%） and 26/32（81.3%）] within three years before treatment（P〈0.01）.The recurrence rate of the medicine group after treatment was lower than that within three years before treatment [76/120（63.3%） vs 96/120（80.0%）,P〈0.05].Compared with the medicine treatment,the endoscopic and surgical treatment reduced the recurrence rate of RAP significantly（P〈0.01）.Conclusion Biliary,metabolic and alcoholic RAP are the major types of RAP.Endoscopic treatment plays an important role in treatment of RAP by significantly reducing the recurrence rate.