早期内镜胆总管Oddi括约肌切开术治疗急性胆源性胰腺炎

TREATMENT OF ACUTE BILLARY PANCREATITIS IN ENDOSCOPI CSPHINCTEROTOMY

目的 :探讨早期内镜胆总管Oddi括约肌切开术 (EST)治疗急性胆源性胰腺炎的临床疗效。方法 :对 42例经内镜胆总管Oddi括约肌切开术和经内镜鼻胆管引流术 (ENBD)等内镜技术治疗的急性胆源性胰腺炎的临床资料进行分析。结果 :42例急性胆源性胰腺炎患者 ,经内镜Oddi括约肌切开后 41例得到治愈 ,1例先天性胆总管囊肿、胆胰管合流异常的病例在EST和ENBD后病情缓解 ,但 3月后再次发生急性胰腺炎 ,经胆总管囊肿切除后才治愈。 2 2例急性胆管炎经ENBD后也迅速缓解 ,2 6例胆总管结石在EST后结石自行排出或用网蓝取出 ;2 0例胆囊结石在胰腺炎治愈后择期行腹腔镜胆囊切除术 ,消除胰腺炎的诱发因素。结论 :内镜治疗直接针对胆源性胰腺炎的发病原因 ,解除胆胰管开口的梗阻 ,排除梗阻因素 ,通畅胆胰液的引流 ,降低胆胰管内压 ,起到了良好的治疗作用 ,有助于防止轻症胰腺炎向重症转化 。

Objective:To investigate the clinical effectiv e of endoscopic Oddi sphincterotomy(EST) in treating acute billary pancreatitis. Methods:The clinical data of 42 patients with acute billary pan creatitis underwent endoscopic Oddi sphincterotomy(EST) and endoscopic nasal-bil lary drainage(ENBD) were analyzed.Results:Forty one out of 42 patients with acute billary pancreat itis were cured after EST. 1 out of 42 with congenital choledochal cyst and ano malous pancreaticobiliary ductal union was lysis after EST and ENBD, but acute p ancreatits recurrent after 3 months, this patient was cured only after the resec tion of choledochal cyst ,22 patients with acute cholangitis were lysis rapidly after ENID, 26 patients with choledocholithiasis excreted the stones by the msel v es or the stones were removed by web basket after EST; 20 patients with cholelit hiasis underwent laparoscopic cholecystectomy choose one day after cure pancreat itis eliminating inducing factor of pancreatitis.Conclusions:Endoscopy treatment can direct to the pathogen of b illary pancreatitis ,and it is the best method to relive the obstrution of the o pening of cholecystopancreatic duct, remove the factor of obstruction, clear drainage of cholicystopancreatic juice, decrease the pressure of intra-cholecys topancreatic duct ,and can help to prevent mild pancreatitis turing to serious o ne .Endoscopic Oddi sphincterotomy is a clinical valuable method to treat billar y pancreatitis.