急诊ERCP对急性胆源性胰腺炎伴胆管炎患者血清淀粉酶水平及肠功能恢复的影响

Effects of Emergency ERCP on Serum Amylase Level and Intestinal Function Recovery in Patients with Acute Biliary Pancreatitis Complicated with Cholangitis

目的:探讨急诊经内镜逆行性胰胆管造影术(ERCP)对急性胆源性胰腺炎(ABP)伴胆管炎患者血清淀粉酶水平及肠功能恢复的影响。方法:回顾性收集2020年2月至2022年2月期间我院肝胆胰腺外科收治的93例ABP伴胆管炎患者作为本次实验的研究对象,依据治疗方法的不同将患者分为实验组(n=48)和对照组(n=45),对照组患者采用保守药物治疗,实验组患者在对照组治疗基础上于入院24至48小时内行急诊ERCP术,比较两组患者症状缓解时间、住院时间、治疗费用、肝功能[谷丙氨酸转氨酶(ALT)、谷草氨酸转氨酶(AST)和谷氨酰转肽酶(GGT)]、肠功能恢复时间、炎症因子[C反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)和肿瘤坏死因子-α(TNF-α)]、血清淀粉酶(SAMY)、白细胞(WBC)、总胆红素(TBIL)水平及恢复时间,记录两组患者并发症发生情况。结果:实验组恶心呕吐消失时间、腹痛缓解时间、退烧时间、住院时间均低于对照组,治疗费用高于对照组(P<0.05)。治疗后两组ALT、AST和GGT等肝功能指标均降低,且实验组低于对照组(P<0.05)。实验组肛门恢复排气时间、开始进食时间和初次自行排便时间较对照组更短(P<0.05)。治疗后两组CRP、IL-6、IL-8和TNF-α等炎症因子水平均降低,且实验组低于对照组(P<0.05)。治疗后两组SAMY、WBC和TBIL等指标均降低,且实验组低于对照组(P<0.05)。实验组SAMY、WBC和TBIL恢复时间均较对照组更短(P<0.05)。实验组并发症发生率为8.33%,低于对照组20.00%,差异无统计学意义(P>0.05)。结论:急诊ERCP治疗ABP伴胆管炎患者,可有效缓解相关症状,改善肝功能,降低炎症因子和SAMY水平,促进肠功能恢复,安全可靠。

Objective:To explore the effects of emergency endoscopic retrograde cholangiopancreatography(ERCP)on serum amylase level and intestinal function recovery in patients with acute biliary pancreatitis(ABP)complicated with cholangitis.Methods:93 patients with ABP complicated with cholangitis who were treated in department of hepatobiliary and pancreatic surgery of the hospital between February 2020 and February 2022 were retrospectively collected as the research subjects of this experiment,and the patients were divided into experimental group(n=48)and control group(n=45)according to the different treatment methods.The patients in control group were treated with conservative drugs while the patients in experimental group underwent emergency ERCP within 24 to 48 hours after admission on the basis of the treatment in the control group.The symptom relief time,hospital stay,treatment cost,liver function indicators[alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(GGT)],intestinal function recovery time,inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)]and levels and recovery times of serum amylase(SAMY),white blood cells(WBC)and total bilirubin(TBIL)were compared between the two groups.The occurrence of complications in the two groups were recorded.Results:The disappearance time of nausea and vomiting,abdominal pain relief time,fever reduction time and hospital stay in experimental group were all shorter than those in control group,and the treatment cost was higher than that in control group(P<0.05).After treatment,the liver function indicators such as ALT,AST and GGT were decreased in the two groups,and the indicators in experimental group were lower than those in control group(P<0.05).The anal exhaust recovery time,time to start eating and first self-defecation time were shorter in experimental group than those in control group(P<0.05).After treatment,the levels of inflammatory factors of CRP,IL-6,IL-8 and TNF-αin the two groups were reduced,and the levels were lower in experimental group compared to control group(P<0.05).After treatment,the SAMY,WBC and TBIL were declined in both groups,and the three indicators in experimental group were lower compared to control group(P<0.05).The recovery times of SAMY,WBC and TBIL in experimental group were shorter than those in control group(P<0.05).The total incidence rate of complications was 8.33%in experimental group,which was lower than 20.00%in control group(P>0.05).Conclusion:Emergency ERCP in the treatment of patients with ABP complicated with cholangitis can effectively relieve the related symptoms,improve the liver function,reduce the levels of inflammatory factors and SAMY,and promote the recovery of intestinal function,thus it is safe and reliable.