早期非手术治疗与早期内镜治疗在胆源性重症急性胰腺炎中的疗效比较

The Comparison of efficacy between early non-surgical treatment and early endoscopic treatment in biliary severe acute pancreatitis

目的:评价早期非手术治疗与早期内镜治疗是否对胆源性重症急性胰腺炎(biliary severe acute pancreatitis,BSAP)存在疗效差异。方法:采用前瞻性随机对照研究方法,将54例BSAP患者分成两组:早期内镜治疗组(early endoscopic intervention,EEI):于发病72h内进行内镜治疗;早期非手术治疗组(early conservative management,ECM):于发病72h内仅给予相关药物治疗,不进行内镜或手术治疗。观察2组入院1周内APACHE-II、SOFA和BalthazarCT评分,2组总的局部和全身并发症发生率以及病死率。结果:EEI组和ECM组APACHE-II评分均值(d0P=0.14,d1P=0.13,d2P=0.20,d3P=0.18,d7P=0.43)、SOFA评分均值(d0P=0.82,d1P=0.56,d2P=0.75,d3P=0.77,d7P=0.55)、Balthazar CT评分(d0P=0.21,d7P=0.27)、局部并发症发生率(25%vs20%,P=0.66)、全身并发症发生率(37.5%vs43.3%,P=0.67)和病死率(8.3%vs15.4%,P=0.56)均无显著差异。结论:本研究未能证实早期内镜治疗可降低BSAP全身和局部并发症,早期内镜治疗与非手术治疗相比无显著性差异。

Objective To evaluate whether there is difference in efficacy between early non-surgical treatment and early endoscopic treatment in biliary severe acute pancreatitis （BSAP）.Methods With a prospective randomized study,54 cases were divided into two groups：early endoscopic intervention group （EEI）,in which endoscopic therapy was performed within 72 hours;and early conservative management group （ECM）,in which patients took medication only within 72 hours,but not endoscopic or surgical treatment.Outcome measures included changes in APACHE-II,SOFA and Balthazar CT score during the first week after admission,incidence of local complications,and overall morbidity and mortality.Results No significant differences were found between the EEI and ECM groups about changes in mean APACHE-II score （d0 P =0.14,d1 P =0.13,d2 P =0.20,d3 P =0.18,d7 P =0.43）,mean SOFA score （d0 P =0.82,d1 P =0.56,d2 P =0.75,d3 P =0.77,d7 P =0.55）,mean Balthazar CT index （admission P =0.205,7 days later P =0.269）,incidences of local complications （25% vs.20%,P =0.67）,overall morbidity （37.5% vs.43.3%,P =0.67）,and mortality （8.3% vs.15.4%,P =0.56）.Conclusion The present study failed to confirm early endoscopic therapy may reduce the BSAP systemic and local complications.Early endoscopic therapy shows no significant differences in superiority of the result.