内镜治疗与其他治疗方法对复发性急性胰腺炎价值对比分析

Comparison of the clinical value of endoscope and other treatment for recurrent acute pancreatitis

目的探讨复发性急性胰腺炎的临床特点以及不同治疗方式的对比分析,以提高对RAP的诊治水平。方法分析2010年1月~2012年12月273例RAP住院患者的临床资料,将其分为药物保守治疗（药物组）、手术治疗组（手术组）以及内镜治疗组（内镜组）,随访治疗效果,并对各组复发情况进行对比分析。结果 RAP的主要病因包括胆道结石30.40%,其次为酒精性因素26.01%,高脂血症18.32%等,所有患者RAP平均复发（1.71±0.96）次,距初次发作时间为（20.67±9.61）个月,3年内复发201例,复发率73.63%。3组的治愈好转率差异无显著性。内镜组随访期内复发12例,复发率为13.04%,手术组随访期内复发19例,复发率为17.59%,两组复发情况与术前3年内复发情况（内镜组复发率73.91%,手术组复发率74.07%）比较显著下降（P〈0.01）;药物组随访期内复发39例,复发率为53.42%,与术前3年内复发率72.60%比较有所下降（P〈0.05）。内镜治疗与手术治疗两种治疗方式同药物保守治疗相比能显著降低RAP的复发（P〈0.01）。结论明确病因后积极治疗原发病因,可有效减少其复发;内镜治疗、内镜下诊断和介入治疗是微创及疗效确切的手段,能显著地减少RAP的复发,值得临床进一步推广。

【Objective】To investigate the clinical features,pathogenic factors of recurrent acute pancreatitis（RAP） and endoscopic treatment,so as to improve the level of diagnosis and treatment of RAP.【Methods】The clinical data of 234 cases of RAP in-patient collected during Dec.2010 to Dec.2012 was analyzed.And,patients were Classified into endoscopic treatment group（endoscopic group）,surgical treatment group（surgical group） and medical treatment group（medical group）.Then,curative effects of each group were followed up.At last,a comparative analysis of recurrence among groups was made.【Result】The main causes of RAP included biliary tract disease 30.40%,alcohol abuse 26.01% and metabolic disease 18.32%.In the 273 cases of RAP,the average recurrence frequency was（1.71±0.96） times.The recurrence interval from the initial onset was（20.67±9.61） months.There were 201 recurrent cases within 3 years with a recurrence rate of 73.63%.The recurrence rates of the endoscopic group and the surgical group after treatment 13.04% and 17.59% significantly decreased as compared with those 73.91% and 74.07% 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（53.42% vs 72.60%）（P 0.05）.Compared with the medicine treatment,the endoscopic and surgical treatment reduced the recurrence rate of RAP significantly（P 0.01）.【Conclusion】Rational diagnosis and therapy is important measure to prevent relapse.Endoscopy therapy for RAP is safe,minimally invasive and effective,and it plays an important role in treatment RAP by greatly reducing the recurrence rate.