胰管括约肌切开联合胰管支架对胆道微结石性急性复发性胰腺炎的疗效评价

Clinical Outcomes of Endoscopic Pancreatic Sphincterotomy Combined with Pancreatic Duct Stenting for Acute Recurrent Pancreatitis Caused by Biliary Microlithiasis

目的探讨胰管括约肌切开（endoscopic pancreatic sphincterotomy,EPS）联合胰管支架置入术治疗胆道微结石性急性复发性胰腺炎的可行性。方法回顾性分析2005年4月-2014年4月我院诊断急性复发性胰腺炎（2次及以上急性胰腺炎发作）且明确病因为胆道微结石52例资料,24例行EPS并胰管支架置入术（EPS组）,28例行内镜下乳头括约肌切开（endoscopic sphincteropapillotomy,EST）并胆道清理术（其中20例鼻胆管引流术）（EST组）,比较2组复发率、术后近期和远期并发症。结果 52例中术后胰腺炎9例,其中EPS组6例（25.0%,6/24）,EST组3例（10.7%,3/28）,无统计学差异（χ^2=0.980,P=0.322）。EPS组随访3-100个月,中位数33个月;EST组随访3-115个月,中位数52个月。5例急性胰腺炎复发,EPS组2例（8.3%,2/24）,EST组3例（10.7%,3/28）,无统计学差异（χ^2=0.000,P=1.000）。EPS组和EST组胆道远期并发症发生率分别为8.3%（2/24）和32.1%（9/28）,有统计学差异（χ^2=4.392,P=0.046）。结论 EPS联合胰管支架置入术治疗胆道微结石导致的急性复发性胰腺炎是可行的。胰管括约肌切开不会引起反流,且能保留胆管括约肌功能。

Objective To investigate the feasibility of endoscopic pancreatic sphincterotomy（ EPS） combined with pancreatic duct stenting for acute recurrent pancreatitis（ ARP） caused by biliary microlithiasis. Methods The clinical data of 52 cases of ARP（ 2 or more attacks of acute pancreatitis） diagnosed in our hospital from April 2005 to April 2014 were retrospectively analyzed. There were 24 cases in EPS group with pancreatic stenting and 28 cases in EST（ endoscopic sphincteropapillotomy） group（ 20 cases with EPBD）. The rate of recurrence and incidence of the early and late complication were compared between the two groups. Results There were 9 cases of post ERCP pancreatitis after the endoscopic therapy,including 6 cases（ 25. 0%） in the EPS group and 3 cases（ 10. 7%） in the EST group. There was no statistical difference between the two groups（ χ^2= 0. 980,P = 0. 322）. During the followup in the EPS group（ median,33 months; range,3- 100 months） and in the EST group（ median,52 months; range,3- 115months）,recurrence of acute pancreatitis occurred in 5 patients,including 2 cases in the EPS group（ 8. 3%） and 3 in the EST group（ 10. 7%）. There was no statistical difference between the two groups（ χ^2= 0. 000,P = 1. 000）. The incidence of long-term complications was 8. 3%（ 2 /24） in the EPS group and 32. 1%（ 9 /28） in the EST group,showing significant difference（ χ^2= 4. 392,P = 0. 046）. Conclusions EPS combined with pancreatic stenting in the treatment of acute recurrent pancreatitis caused by biliary calculi is feasible. EPS does not cause reflux and help recover the biliary sphincter function.