三种方式治疗急性胆源性胰腺炎的临床研究

A clinical study of three methods for treating acute biliary pancreatitis

目的探讨内镜逆行性胰胆管造影(ERCP)+内镜下十二指肠乳头括约肌切开(EST)+内镜下鼻胆管引流(ENBD)、超声引导下经皮经肝胆囊穿刺引流(PTGD)及保守治疗三种方式治疗急性胆源性胰腺炎(ABP)的临床疗效,比较ERCP+EST+ENBD与PTGD治疗ABP的临床价值。方法回顾分析2017年9月~2019年12月收住锦医大一院126例ABP患者的临床资料,按治疗方式不同分为ERCP组(n=41),PTGD组(n=30),保守组(n=55)。分析三组间检验室指标及非检验室指标。结果①经治疗3 d后检验室指标比较,与保守组相比,ERCP组及PTGD组的WBC、SAMY、TBIL、ALT下降显著且其恢复正常时间更短;与PTGD组相比,ERCP组TBIL下降更明显,差异均有统计意义(P均<0.05),其余指标无明显差异(P均>0.05)。②非检验室指标比较:与保守组相比,ERCP组及PTGD组腹痛腹胀缓解时间、经口进食时间、住院时间均减短、并发症发生率减小,ERCP住院费用增多及复发率降低、PTGD住院费用减少,差异均有统计学意义(P均<0.05);与PTGD组相比,ERCP组经口进食时间减短,住院费用增加,差异均有统计学意义(P<均0.05),其余指标无明显差异(P均>0.05)。结论ERCP可作为ABP患者优选治疗方法;PTGD可作为ERCP的替代治疗方法;PTGD能安全有效减轻胆道压力,具有较高的临床推广价值。

Objective To investigate the clinical efficacy of endoscopic retrograde cholangio-pancreatography(ERCP)+endoscopic sphincterotomy(EST)+endoscopic naso-biliary drainage(ENBD),ultrasound-guided percutaneous transpepatic gallbladder drainage(PTGD),and conservative treatment on acute biliary pancreatitis(ABP)and to compare the clinical value of ERCP+EST+ENBD and PTGD in the treatment of ABP.Methods The clinical data of 126 patients with ABP admitted to and hospitalized in the First Affiliated Hospital of Jinzhou Medical University from September 2017 to December 2019 were retrospectively analyzed and were divided into the ERCP group(n=41),the PTGD group(n=30)and the conservative group(n=55)according to different treatment methods.The laboratory indicators and the non-laboratory indicators were analyzed among the three groups.Results①When the laboratory indicators were compared after 3 d of treatment,compared with those of the conservative group,the WBC,SAMY,TBIL and ALT of the ERCP group and the PTGD group decreased more significantly and the return-to-normal time was shorter.Compared with that of the PTGD group,the decrease of TBIL in the ERCP group was more significant,and the differences were all statistically significant(In each case,P<0.05),while there was no significant difference in the other indexes(P>0.05).②In terms of the non-laboratory indicators,when compared with those of the conservative group,the relief time of abdominal pain and distension,the oral feeding time and the hospitalization time of the ERCP group and the PTGD group all shortened,the incidence rate of complications was reduced.The hospitalization expense of ERCP increased and the recurrence rate decreased,and the hospitalization expense of PTGD decreased,and the differences were all statistically significant(In each case,P<0.05).Compared with those of the PTGD group,the oral feeding time of the ERCP group decreased and the hospitalization expense increased,and the differences were all statistically significant(In each case,P<0.05),while there was no significant difference in the other indexes(P>0.05).Conclusion ERCP can be taken as the preferred therapy for the patients with ABP.PTGD can be taken as an alternative therapy to replace ERCP.PTGD can reduce the pressure of biliary tract safely and effectively,which is of greater value for clinical promotion.