急性胆源性胰腺炎内镜诊治疗效及安全性

Value and safety of ERCP and endoscopic treatment for acute biliary pancreatitis

目的:探讨急性胆源性胰腺炎患者内镜逆行胰胆管造影(ERCP)及内镜治疗的应用价值和安全性。方法:91例次急性胆源性胰腺炎患者作ERCP及内镜治疗,其中轻型胰腺炎78例,重症胰腺炎13例。以同期保守治疗的重症胆源性胰腺炎15例作为实施ERCP的重症胰腺炎的对照组.观察患者胰腺炎的确切病因、治疗效果及并发症发生情况。结果:56例为胆道疾患,其中胆总管结石26例,胆囊结石17例,微胆石4例,胆管炎9例。乳头旁巨大憩室3例,乳头及胆总管下端炎症5例,2例次为胰管分裂,25例ERCP未见异常。46例做了内镜下治疗,其中内镜下十二指肠乳头括约肌切开术及取石术21例次,2例次作了副乳头切开及扩张术,19例次作了鼻胆管引流术。ERCP组中重症胰腺炎的腹痛缓解天数(4.4±2.0 d),体温正常时间(5.0±3.4d),白细胞正常时间(6.5±5.4 d)及平均住院天数(21.9±8.4 d)明显短于对照组(8.4±6.1 d,16.1±19.0 d,19.1±19.3d,41.3±20.0 d,P<0.05)。淀粉酶正常时间(3.4±1.6 d)与对照组(4.5±2.8 d)比较无差异(P>0.05),并发症发生率(53.9％)和死亡率(0％)也低于对照组(80.0％,23.1％)。ERCP后出现早期并发症17例(18.7％),其中胆道感染2例(2.2％),腹膜后积气1例(1.1％),消化道大出血1例(1.1％),胰腺炎加重13例。经内科保守治疗痊愈15例(88.2％),外科手术治疗1例(1.1％)、死亡1例(1.1％)。结论:急性胆源性胰腺炎患者ERCP可发现确切病因,内镜治疗是有效的,安全的。

AIM: To evaluate the value and safety of endoscopic ret- rograde cholangiopancreatography (ERCP) and endoscopic treatment in acute biliary pancreatitis. METHODS: Ninety-one patients with acute biliary pancreatitis including 13 patients with severe acute biliary pancreatitis in the ERCP group underwent ERCP and endoscopic therapy. 15 patients with severe acute biliary pancreatitis were not treated by either surgery, endoscopy or early ERCP in the control group. Etiological factors, therapeutic effects and complications were observed in all the patients of the two groups. RESULTS: In ERCP group, ERCP showed biliary tract disease in 56 cases, Common bile duct stones in 26, cholecyst stone in 17, microcholelith in 4, cholangitis in 9, larger diverticula around the papilla in 3, papillitis in 5, pancreatic diverticulum in 2, and normal in 25.46 cases of biliary tract disease were treated by endoscopy including papillosphincterotomy, endoscopic nasal biliary drainage and endoscopic dilatation of the accesory papilla. There were no significant differences in the recovery days of serum amylase back to normal be- tween ERCP group (3.4±1.6 d) and control group (4.5±2.8 d), but the mean days or disappearance of abdominal pain (4.4±2.0 d), fever (5.0±3.4 d), abnormal white blood cell count (6.5±5.4 d) and hospitalization (21.9±8.4 d) were significantly shorter in the ERCP group than in the control group (8.4±6.1 d, 16.1±19.0 d, 19.1±19.3 d, 41.3±20.0 d, P<0.05). Complication rate (53.9%) and mortality rate (0%) in ERCP group were lower than those of control group (80.0%, 23.1% P<0.05). 17 cases had early com- plication (18.7%) in ERCP group. Of them, biliary tract infection occurred in 2 cases (2.2%), retroperitoneal pneu- matosis in 1 case (1.1%), bleeding of digestive tract in 1 case (1.1%), deterioriation of pancreatitis in 13 cases. 15 patients were cured bv medication treatment. Operations were performed in one patient. One patient died. CONCLUSION: ERCP and endoscopic therapy are safe and effective for patients with acute pancreatitis.