应用EST技术治疗急性胆源性胰腺炎的临床体会

Treatment of acute gallstone pancreatitis by endoscopic sphincterotomy

目的 探讨内镜下乳头Oddi括约肌切开术(endoscopic sphincterotomy,EST)在急性肌源性胰腺炎(acute gallstone pancreatitis,AGP)诊治中的应用价值。方法 将入选的189例AGP患者随机分为EST治疗组(n=79)和对照组(n=110),并根据APACHE Ⅱ评分,将每组再进一步分为重症组和轻症组,两组患者均给予中西医结合治疗。EST治疗组在入院后24h内行内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)+EST,如发现胆总管或胆胰共同通道有结石,则行网篮、气囊取石或碎石器碎石后取石,如结石多、结石直径大或取石未净,则EST术后再行鼻胆管引流术(endoscopic nasobilliary drainage,ENBD)。结果 对重症AGP,EST治疗组的并发症发生率转开腹手术率、住院天数及住院费用均明显低于对照组(P<0.05);而轻症AGP,两组之间无显著差异结论 早期应用EST技术治疗重症AGP是有效的和安全的。

Objestive To validate the clinical use of endoscopic sphincterotomy (EST) in the treatment of acute gallstone pancreatitis (AGP). Methods 189 patients with AGP were randomly divided into EST group (n = 79) and non-EST control group (n = 110),and each group was further broken down into severe group and moderate group according to the APACHE I score. Patients of both EST and control groups were treated with the combination of traditional Chinese and Western medicine. Endoscopic retrograde cholangiopancreatography (ERCP) plus EST was performed in patients of the EST group 24h after hospitalization. Lithotomy was carried out by the basket or lithotriptor if stones were found in the common bile duct or in the billiary and pancreatic common path. Endoscopic nasobilliary drainage (ENBD) was done after EST if there were multiple stones, or the stones were relativelylarge, or there were residual stones after lithotomy. Results For severe AGP, the morbidity rate, rate of laparotomy, hospital stay and hospitalization expenses were significiantly lower in EST group than those in the non-EST control groups(P<0. 05),and for moderate AGP,there was no significant different between two groups. Conclusions EST is safe and effective in the early treatment of severe AGP.