床边急诊ERCP在重症急性胆源性胰腺炎治疗中的应用16例

Application of bedside emergency ERCP in the treatment of severe acute biliary pancreatitis

目的:探讨床边非X线引导下急诊逆行性胰胆管造影(endoscopic retrograde cholangiopancre atography,ERCP)在重症急性胆源性胰腺炎治疗中的价值.方法:34例重症监护室(intensive care unit,ICU)住院重症急性胆源性胰腺炎患者,治疗组16例行急诊床边非X线引导下ERCP术,选择性胆管插管回抽出胆汁证实胆管插管成功,必要时行十二指肠乳头括约肌切开取石,常规留置鼻胆引流管引流,病情稳定后必要时行2次ERCP诊疗.对照组18例接受常规内科综合治疗.对照两组患者临床效果与医疗费用.结果:治疗组选择性胆管插管成功率为100%,2次E R C P术共4例,全部患者治愈出院.治疗组腹痛缓解时间4.38d±1.31d快于对照组11.72d±2.76d(P<0.05),住院时间12.69d±3.09d较对照组25.61d±7.41d明显缩短(P<0.05),治疗费用4.77万元±0.97万元明显低于对照组10.04万元±2.29万元(P<0.05),并发症发生率(6.25%)低于对照组(44.44%)(P<0.05),死亡率(0%)与对照组(11.11%)无显著差异(P>0.05).结论:床边非X线引导下急诊ERCP治疗是重症胆源性胰腺炎救治的安全有效方法.

AIM：To investigate the reliability and validity of bedside emergency endoscopic retrograde cholangiopancreatography（ERCP） without X-ray guidance in the treatment of severe acute biliary pancreatitis.METHODS：Thirty-four patients with severe acute biliary pancreatitis in intensive care unit were enrolled into this prospective study.These patients were divided into either a treatment group（n = 14） or a control group（n = 18）.The control group underwent routine comprehensive medical treatment.The treatment group was treated by bedside emergency ERCP without X-ray guidance.Selective bile duct cannulation was performed,and the success of intubation was confirmed by pumping back bile through ducts.Duodenal papilla sphincterotomy lithotomy,routine indwelling nose bile drainage,and secondary ERCP were conducted in case of necessity.Clinical effectiveness and costs were compared between the two groups.RESULTS：All patients in the treatment group received successful selective bile duct intubation,and six of them needed secondary ERCP.Average time of abdominal pain relief was significantly less in the treatment group than in the control group（4.38 d ± 1.31 d vs 11.72 d ± 2.76 d,P 0.05）.The average hospitalization time was significantly shorter（12.69 d ± 3.09 d vs 25.61 d ± 7.41 d）,P 0.05） and the cost of hospitalization was significantly lower（4.77 × 10 4 RMB ± 0.97 × 10 4 RMB vs 10.04 × 10 4 RMB ± 2.29 × 10 4 RMB,P 0.05） in the treatment group than in the control group.Incidence of complications was significantly lower in the treatment group than in the control group（6.25% vs 44.44%,P 0.05）.No statistic difference in mortality was found between the two groups.CONCLUSION：Bedside emergency ERCP without X-ray guidance is a safe and effective treatment for severe acute biliary pancreatitis.