ERCP治疗急性胆源性胰腺炎的时机及临床疗效分析

Analysis of operation timing and clinical efficacy of endoscopic retrograde cholangiopancreatography in the treatment of acute biliary pancreatitis

目的评估经内镜逆行性胰胆管造影术(ERCP)治疗急性胆源性胰腺炎的时机、临床疗效及安全性,方法回顾性分析2015年10月-2017年7月武汉市江夏区第一人民医院收治的75例急性胆源性胰腺炎患者的临床资料,其中男性45例,女性30例;年龄(46.35 ±& 95)岁,年龄范围25 ~72岁。所有患者均行ERCP治疗,根据治疗时机的不同将其分为24 -72 h组(发病至行ERCP治疗时间为24 -72 h)16例、72~120 h组(发病至行ERCP治疗时间为72 - 120 h)25例和m 120 h组(发病至行ERCP治疗时间>120 h)34例,详细记录三组患者术中及术后各临床指标、治疗前后实验室指标、手术并发症发生率、复发率及病死率并进行比较正态分布的计量资料以均数士标准差(Mes 士SO)表示,三组之间比较采用F检验,两组之间比较采用r检验,计数资料数据之间比较采用#检验。结果24 -72 h组腹痛缓解时间、淀粉酶恢复时间、住院时间及住院费用分别为(4.48 ± 1.29) d、(3.59 ± 1.22) d、(7. 24 ± 1.55 )<1.(1.55 ±0.31)万元,72 -120 h 组分别为(7.35 ±1.76) d.(4.91 ±1.37) d、( 13. 61 ±2.13) d、(2.02 ±0. 37)万元,M120 h 组分别为(11.21 ±2.02) d、(8.86±1.95) d、(21.58 ±2.86) d、(2.49 ±0.52)万元,任意两组相比差异均具有统计学意义(P <0. 05)。治疗后24 ~72 h组血淀粉酶、总胆红素、C反应蛋白及白细胞计数分别为(319.65 ±58.93) U/L、( 14.22 ± 2. 84)?mol/L、(31. 12 ±5. 35) mg/L 及(6. 84 ± 1. 17) x 109/L,72 ~120 h 组分别为(362. 87 ±63.37) U/L、( 16. 39 ±3. 14)?mol/L、(37. 34 ±6.12) mg/L 及(7. 93 + 1.36) x109/L,S120 h 组分别为(452.61 ±75.49) U/L、(20. 28 ±3.67) p,mol/LJ46. 19 ±6.98) mg/L 及(9. 77 士1.52) x109/L,任意两组相比差异均具有统计学意义(P<0.05) 24 -72 h组手术并发症发生率、复发率及病死率分别为 25.00%(4/16) J2. 50%(2/16)及 0(0/16),72 - 120 h 组分别为 24. 00%(6/25 ) J2. 00%(3/25)及 0(0/25),2120 h组分别为 29.41%(10/34),20. 59%(7/34)及 5. 88%(2/34),24 ~ 72 h 组、72 ~120 h组与M120 h组相比差异均具有统计学意义(P<0.05);但24 -72 h组与72 - 120 h组相比差异无统计学意义(P >0.05)。结论24 -72 h与72 ~ 120 h内行ERCP治疗急性胆源性胰腺炎均安全有效,但24 ~72 h内行ERCP治疗患者实验室指标改善更为明显,且患者住院吋间更短、住院费用更省,更具临床优势。

Objective To discuss the operation tiining, clinical efficacy and safety of endoscopic retrograde cholangiopancreatography ( ERCP ) in the treatment of acute biliary pancreatitis. Methods Retrospective analyzed the clinical data of 65 acute biliary pancreatitis patients in First People's Hospital of Jiangxia District, Wuhan city form October 2015 to July 2017 , there were 45 males and 30 females, the age was (46. 35 ± 8. 95 ) years ( range, 25-72 years). All patients were treated with ERCP, and divided into 24-72 h group (the time from onset to ERCP treatment 24-72 h ) 16 cases,72-120 h group ( the time from onset to ERCP treatment 72- 120 h) 25 cases and 120 h group ( the time from onset to ERCP treatment M 120 h ) 34 cases, recorded and compared the clinical indexes during and after operation, laboratory indexes before and after treatment, incidence of surgical complications, recurrence rate and mortality. The measurement data with normal distribution were expressed as mean ± standard deviation ( Mean ± SD), the F test was used for comparison among the three groups, and the t test was used for comparison between the two groups, the count data were compared bytest, and the rank sum test was used to compare the incidence of surgical complications. Results The abdominal pain relief time, amylase recovery time, length of stay and hospitalization expenses of the 24-72 h group were (4. 48 ± 1.29 ) d,( 3. 59 ± 1.22) d,(7. 24 ± 1.55) d and (1.55 ± 0. 31 ) ten thousand yuan respectively, the 72-120 h group were (7. 35 ± 1.76) d,(4.91 ± 1.37) d,(13.61 ±2. 13) d,(2. 02 ±0. 37) ten thousand yuan respectively, the 三 120 h group were (11.21 ±2.02) d,(8. 86 ± 1.95) d,(21.58 ±2. 86) d,(2.49 ±0.52) ten thousand yuan respectively, with significant differences between any two groups(P < 0.05). The serum amylase, total bilirubin, c-reactive protein and white blood cell levels of the 24-72 h group were (319. 65 ± 58. 93) U/L,( 14. 22 ± 2. 84)|xmol/L,( 31. 12 ± 5. 35) mg/L and (6. 84 ± 1. 17) x 109/L respectively, the 72-120 h group were (362. 87 ±63. 37) U/L,(16. 39 士 3. 14)|imol/L,(37. 34 ±6. 12) mg/L and (7.93 ± 1.36) x 109/L respectively, the 120 h group were (452. 61 ± 75.49) U/L,( 20. 28 ± 3. 67 )|imol/L,(46. 19 ±6. 98) mg/L and (9. 77 ± 1.52) x 109/L respectively, with significant differences between any two groups (P <0. 05). The incidence of surgical complications, recurrence rate and mortality of the 24-72 h group were 25. 00%(4/16), 12.50%(2/16) and 0 (0/16) respectively, the 72-120 h group were 24.00%(6/25), 12.00%(3/25) and 0 (0/25) respectively,the 120 h group were 29.41 %(10/34), 20. 59%(7/34) and 5. 88%(2/34) respectively, with significant differences between 24-72 h group, 72-120 h group and Ml20 h group (P <0.05);But there was no significant difference between the 24-72 h group and the 72-120 h group (P >0. 05). Conclusion In the treatment of acute biliary pancreatitis within 24-72 li and 72-120 h are safe and effective, but the improvement of laboratory7 indexes within 24-72 of stay is shorter, the hospitalization expenses is more provincial, and h ERCP treatment is more obvious, the length with more clinical advantage. Pancreatitis;Postoperative complications.