胰管支架治疗高三酰甘油血症性胰腺炎的疗效:附33例报告

Efficacy of pancreatic duct stenting in treatment of hypertriglyceridemic pancreatitis:a report of 33 cases

背景与目的:高三酰甘油血症性胰腺炎(HTGP)发病率逐年增高,至今没有相关的治疗指南,目前主要采用以降脂为主的保守治疗,但治疗效果并不理想,病死率和并发症发生率仍然较高,预后也相对较差,因此单纯的保守治疗存在一定局限性。本研究评价胰管支架置入治疗HTGP患者的有效性和安全性,以期为临床治疗提供新的思路。方法:回顾分析作者单位2017年1月—2020年7月所有经胰管支架置入治疗的HTGP患者临床资料,根据纳入与排除标准筛选入组病例。统计纳入病例的胰管梗阻情况;比较入院及治疗48 h后的APACHEⅡ评分、血清甘油三酯(TG)水平、血糖水平;记录治疗后并发症发生率、病死率、新发器官功能衰竭发生率、禁食时间、住院时间、住院花费等。结果:共纳入33例患者,其中男15例,女18例;33例患者平均年龄(37.42±9.69)岁,血清TG水平中位数19.83(11.85~39.18)mmol/L;其中16例存在胰管蛋白栓,胰管蛋白栓在轻、中、重度HTGP中的发生率分别为17%、56%、100%,与无胰管蛋白栓患者比较,有胰管蛋白栓的患者病情更重。2例(6%)发生与ERCP有关的血清淀粉酶升高;3例(9%)发生术后并发症。所有患者通过胰管支架全部治愈,于入院后3(2~5)d恢复经口进食,住院时间中位数为5(3~9)d,治疗48 h后APACHEⅡ评分较入院时降低约70%,发病48 h内行胰管支架置入的患者禁食时间、住院时间较发病48 h后行胰管支架置入的患者分别缩短33%、38%,住院花费减少33%,差异均有统计学意义(均P<0.05)。结论:早期胰管支架治疗可以快速缓解HTGP患者的临床症状、大幅度减少住院时间并改善患者预后,是一种安全有效的治疗新策略。

Background and Aims:The incidence rate of hypertriglyceridemic pancreatitis(HTGP)has been continuously increasing in recent years,and there is no relevant guideline for its treatment available so far.Currently,the main treatment is conservative treatment based on lipid-lowering therapy,but the treatment efficacy is unsatisfactory,and the mortality and incidence rates of complications are still high,so the prognosis is relatively poor.Therefore,simple conservative treatment has some limitations.This study was conducted to evaluate the effectiveness and safety of pancreatic duct stent implantation in the treatment of HTGP,so as to provide a new approach for clinical management of this condition.Methods:The clinical data of all patients with HTGP undergoing pancreatic duct stenting from January 2017 to July 2020 were reviewed,and the eligible patients were picked up according to the inclusion and exclusion criteria.In the included patients,the incidence of pancreatic ductal obstruction was observed;the APACHEⅡscore,serum triglyceride(TG)level and blood glucose level were compared between admission and 48 h after treatment;the incidence of complications,mortality,incidence of new organ failure,the lengths of time for fasting and hospitalization as well as the hospitalization expenses were analyzed.Results:A total of 33 patients were included,with 15 males and 18 females.Of the patients,the average age was(37.42±9.69)years,and the median serum TG level was 19.83(11.85-39.18)mmol/L;16 cases had pancreatic duct protein thrombus,and the incidence rates of pancreatic duct protein thrombus in cases with mild,moderate and severe HTGP were 17%,56%and 100%,respectively.The severity of illness in patients with pancreatic duct protein thrombus was greater than those without pancreatic duct protein thrombus.Two patients(6%)developed post-ERCP hyperamylasemia,and postoperative complications occurred in 3 patients(9%).All patients were cured after pancreatic duct stenting.The median time of oral feeding was 3(2-5)d,and the median length of hospital stay was 5(3-9)d.After 48-h treatment,the APACHEⅡscore decreased by approximately 70%compared with that at admission.In patients who underwent pancreatic duct stenting within 48 h after onset,the fasting time and hospitalization time were shortened by 33%and 38%,and the hospitalization cost was reduced by 33%compared with those undergoing pancreatic duct stenting over 48 h after onset,and all the differences had statistical significance(all P<0.05).Conclusion:Early pancreatic duct stenting treatment can quickly alleviate the clinical symptoms of HTGP patients,significantly reduce the length of hospital stay and improve the prognosis.It is a safe and effective new treatment strategy.