早期内镜治疗老年急性胆源性胰腺炎对炎症因子及临床疗效的影响

Effects of early endoscopic therapy on inflammatory factors and efficacy in elderly patients with acute biliary pancreatitis

目的探讨早期内镜治疗对老年急性胆源性胰腺炎(acute biliary pancreatitis,ABP)炎症因子及临床疗效的影响。方法回顾性分析2010年1月至2019年12月间上海市浦东新区周浦医院肝胆外科收治的老年ABP 206例,依据治疗方式不同分成观察组(102例)和对照组(104例)。观察组采用内镜下括约肌切开(EST)取石、鼻胆管引流术(ENBD)治疗,对照组采取常规综合治疗。观察两组患者治疗后临床症状、血清炎症因子的变化及并发症发生率和病死率。结果治疗后两组患者血清C反应蛋白(CRP)、血清淀粉样物质A(SAA)、IL-6、IL-8和TNF-a的水平均较治疗前有显著下降(P均<0.05),且观察组治疗后血清CRP、SAA、IL-6、IL-8和TNF-a水平下降较对照组更显著(P均<0.05)。观察组腹痛缓解时间、体温降至正常时间及住院天数分别为(3.92±1.54)、(3.63±1.41)、(14.35±2.46)d,较对照组的(5.81±1.72)、(5.45±2.13)、(19.37±3.12)d明显缩短(P值均<0.05)。观察组治疗后APACHEⅡ评分为(10.02±2.67)分,较对照组的(12.35±3.62)分下降更显著(t=4.42,P<0.05)。观察组治疗后并发症发生率为10.78%,低于对照组的24.03%(χ^(2)=6.27,P<0.05)。观察组的病死率(1.96%)低于对照组(4.81%),但差异无统计学意义(χ^(2)=1.28,P>0.05)。结论早期内镜治疗老年人ABP患者安全有效,具有住院时间短、炎症消退快、并发症发生率低等优点。

Objective To evaluate the inflammatory factors effects of early endoscopic therapy for elderly patients with acute biliary pancreatitis(ABP)and its clinical efficacys.Methods 206 elderly patients with ABP admitted from Jan.2010 to Dec.2019 were divided into observation group(102 cases)and the control group(104 cases)according to treatment method.The observation group received endoscopic retrograde cholangiopancreatography(ERCP),endoscopic sphincterotomy(EST)and endoscopic naso-biliary drainage(ENBD),while the control group received conventional treatment.Clinical symptoms,changes of inflammatory factors,complications and prognosis were observed in each group.Results CRP,SAA,IL-6,IL-8 and TNF-a after treatment were significantly lowered than those before treatment(P<0.05).In addition,the levels of CRP,SAA,IL-6,IL-8 and TNF-a in the observation group were significantly lower than those in the control group(P<0.05).The time to abdominal pain extinction,time to fever cessation,hospital stay in observation group were(3.92±1.54),(3.63±1.41),and(14.35±2.46)d,significantly less than those in the control group[(5.81±1.72),(5.45±2.13),(19.37±3.12)d,P<0.05].APACHEⅡscore of the observation group was(10.02±2.67)point after treatment,significantly lower than that in the control group[(12.35±3.62)point,t=4.42,P<0.05].The incidence of complications in the observation group was 10.78%after treatment,significantly lower than that in the control group[(24.03%),χ^(2)=6.27,P<0.05].The mortality in the observation group was 1.96%,lower than 4.81%in the control group,with no statistical significance.Conclusion Early endoscopic therapy is safe and highly effective for elderly patients with ABP,with the advantages of shorter hospital stay,quicker subsided inflammation,and lower incidence of complications.