急性胆源性胰腺炎内镜治疗时机的选择

The timing of endoscopic therapy of acute biliary pancreatitis

目的探讨应用十二指肠镜治疗急性胆源性胰腺炎(ABP)的手术时机。方法回顾性分析2008年10月至2012年10月应用十二指肠镜治疗的72例ABP患者的临床资料,其中轻型梗阻型17例,轻型非梗阻型47例,重型梗阻型8例。结果 24h内实施经内镜逆行胰胆管造影(ERCP)治疗38例(轻型梗阻型17例,轻型非梗阻型13例,重型梗阻型8例),其中2例重型ABP因十二指肠黏膜重度水肿,导致ERCP失败,在超声引导下行经皮经肝胆囊穿刺置管引流术(PTGBD),术后死亡1例。34例轻型非梗阻型ABP经保守治疗24h,病情加重18例,急诊行ERCP治疗。单纯性胆总管结石行ERCP治疗,一次取净结石19例;ERCP治疗术后部分患者出现胰腺炎、感染加重以及迟发性出血等近期并发症,经积极保守治疗后均恢复正常。结论 ABP治疗需遵循"个体化"及"损伤控制"的原则,对轻型非梗阻型ABP可采取保守治疗,保守治疗无效的轻型非梗阻型ABP以及梗阻型、重型ABP应早期选择ERCP治疗。

Objective To investigate the timing of endoscopic therapy of acute biliary pancreatitis （ ABP ）. Methods Seventeen mild obstructive cases, 47 mild non-obstructive cases and 8 severe obstructive cases of acute biliary pancreatitis from October 2008 to October 2012 were analyzed retrospectively. Results Thirty-eight cases had endoscopic retrograde cholangiopancreatography（ ERCP ） operations within 24 hours. Two cases of severe ABP had percutaneous transhepatic gallbladder drainage for the failure of ERCP due to the duodenal mucosa severe edema. Eighteen cases had acute ERCP among the 34 mild non-obstructive cases of ABP with conservative treatment after 24 hours for the aggravating pathogenetic condition. Simple common bile duct stones underwent ERCP treatment and all the common bile duct stones had been cleaned well only in 19 cases. Some patients had severe acute pancreatitis, infection and delayed bleeding, but all the cases were restored to normal by conservative treatment. Conclusions The treatment of ABP must follow the principle of ＂individual＂ and ＂damage control＂. The mild non-obstructive ABP can have conservative treatment first, but the invalid, obstructive ABP and severe cases should have early ERCP treatment.