内镜下括约肌切开取石联合鼻胆管引流术治疗急性胆源性胰腺炎

Endoscopic sphincterotomy combined with nasobiliary drainage in the treatment of acute biliary pancreatitis

目的探讨内镜下括约肌切开取石联合鼻胆管引流术治疗急性胆源性胰腺炎的临床疗效。方法回顾性分析浙江省永康市第一人民医院2017年1月-2020年12月收治的160例急性胆源性胰腺炎患者的临床资料,将腹腔镜胆总管切开+胆道镜探查+T管引流术治疗的80例归为腹腔镜胆总管切开组,经内镜下括约肌切开取石联合鼻胆管引流术治疗的80例归为括约肌切开取石组,比较两组手术前后炎症因子(IL-6、IL-8、TNF-α及AMS)水平、急性胰腺炎评分与APACHEⅡ评分情况及术后情况(肛门排气时间、腹痛缓解时间、引流时间、体温正常时间、住院时间)。结果术后3天括约肌切开取石组上述指标均较腹腔镜胆总管切开组显著降低,差异有统计学意义(P<0.01);术后3天、7天括约肌切开取石组急性胰腺炎评分与APACHEⅡ评分均显著小于腹腔镜胆总管切开组,差异具有统计学意义(P<0.01);括约肌切开取石组术后肛门排气时间、腹痛缓解时间、引流时间、体温正常时间、住院时间明显缩短,较腹腔镜胆总管切开组差异具有统计学意义(P<0.01)。结论内镜下括约肌切开取石联合鼻胆管引流术均有较好的疗效,且患者术后住院时间短、恢复快。

Objective To investigate the clinical effect of endoscopic sphincterotomy combined with nasobiliary drainage in the treatment of acute biliary pancreatitis.Methods The clinical data of 160 patients with acute biliary pancreatitis treated in the first people's Hospital of Yongkang City,Zhejiang Province from January 2017 to December 2020 were analyzed retrospectively.80 patients treated by laparoscopic choledochotomy+choledochoscopy+T-tube drainage were classified into laparoscopic choledochotomy group,80 patients treated by endoscopic sphincterotomy combined with nasobiliary drainage were divided into sphincterotomy group.The inflammatory factors(IL-6、IL-8、TNF-α)before and after operation were compared between the two groups And AMS,acute pancreatitis score,APACHE II score and postoperative situation(anal exhaust time,abdominal pain relief time,drainage time,normal temperature time and hospital stay).Results Three days after operation,the above indexes in sphincterotomy group were significantly lower than those in laparoscopic choledochotomy group(P<0.01);The scores of acute pancreatitis and ApacheⅡin sphincterotomy group were significantly lower than those in laparoscopic choledochotomy group at 3 and 7 days after operation(P<0.01);The anal exhaust time,abdominal pain relief time,drainage time,normal temperature time and hospital stay in the sphincterotomy group were significantly shorter than those in the laparoscopic choledochotomy group(P<0.01).Conclusion Endoscopic sphincterotomy combined with nasobiliary drainage is effective,and the postoperative hospital stay is short and the recovery is fast.