内镜逆行胰胆管造影术治疗急性胆源性胰腺炎的临床观察

CLINICAL EFFECTS OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY ON THE TREATMENT OF ACUTE BILIARY PANCREATITIS

目的探讨内镜逆行胰胆管造影术治疗急性胆源性胰腺炎的临床疗效。方法选取在2012年1月-2014年1月收治的急性胆源性胰腺炎（ABP）患者80例,按入院先后顺序分为观察组和对照组各40例,对照组仅行常规药物保守治疗,观察组在常规保守治疗基础上加用内镜逆行胰胆管造影术（ERCP）治疗。结果治疗3 d时的全身严重程度APACHEⅡ评分观察组为（6.47±2.01）分,明显小于对照组（p〈0.05）;治疗后的炎症因子TNF-α和CRP分别为（135.63±24.13）μg/L、（21.58±7.32）mg/L,明显小于对照组（p〈0.05）;治疗后腹痛缓解时间、肠道恢复通气时间、血清淀粉酶恢复正常的时间和住院时间分别为（2.5±0.3）、（3.6±1.2）、（5.6±1.3）、（11.3±2.4）d,均明显小于对照组（均p〈0.05）;仅1例患者发生并发症,明显小于对照组（p〈0.05）。结论在常规保守治疗的基础上加用ERCP治疗ABP,可快速改善患者全身状况,降低炎症反应,改善临床症状,减少并发症发生率,提高救治率。

Objective To discuss the clinical effect of endoscopic retrograde cholangiopancreatography on acute biliary pancreatitis. Methods According to the admission sequence,80 patients with acute biliary pancreatitis（ ABP） hospitalized from January 2012 to January 2014 were divided into observation group and control group equally. The control group only underwent conventional medical conservative treatment,while observation group was treated with endoscopic retrograde cholangiopancreatography（ ERCP） based on conventional medical conservative treatment. Results After 3 days treatment,the systemic severity was compared,and the APACHE II score of observation group was（ 6. 47 ± 2. 01）,significantly smaller than the control group（ p〈0. 05）,and the scores on inflammatory factor TNF- α and CRP of observation group were（ 135. 63 ± 24. 13） μg / L,（ 21. 58 ± 7. 32） mg / L,also significantly smaller than the control group（ p〈0. 05）,and the time of abdominal pain relief,the recovery time of intestinal ventilation and the time of serum amylase returned to normal level,and the hospital stay was（ 2. 5 ± 0. 3）d,（ 3. 6 ± 1. 2） d,（ 5. 6 ± 1. 3） d,（ 11. 3 ± 2. 4） d,obviously shorter than the control group（ p〈0. 05）. Only one case in the observation group contracted complications,fewer than that in the control group（ p〈0. 05）. Conclusion ERCP based on conventional medical conservative treatment for patients with acute biliary pancreatitis can improve their general condition and clinical symptoms,reduce inflammation,decrease the incidence of complications and increase the curative rate.