急诊治疗性逆行胆胰管造影对重症急性胆源性胰腺炎的疗效

目的探讨应用急诊治疗性逆行胆胰管造影(endoscopic retrograde cholangio pancerea-tography,ERCP)对重症急性胆源性胰腺炎的诊治与临床疗效。方法将2002年2月至2006年7月的264例胆源性SAP(severe acute pancreatitis;SAP),随机分为急诊ERCP治疗组(140例)及药物治疗组(124例);两组患者接受相同内科基础治疗,急诊ERCP治疗组在此基础上,急诊施行十二指肠乳头括约肌切开(EST)及鼻胆管引流(ENBD)或鼻胰管引流(ENPD);对疑有胆总管结石梗阻者、在EST后经内镜取石。记录两组血淀粉酶恢复与腹痛缓解时间、中转手术率、并发症发生率和平均住院天数及费用,评定入院1d、3d、6d患者的APACHEⅡ评分。结果急诊治疗性ERCP成功137例、取石成功率约为74·5%,留置ENBD或ENPD的成功率为97·8%,急诊ERCP治疗组的血淀粉酶恢复正常与腹痛缓解时间较短、患者入院后APACHEⅡ评分亦较药物治疗组下降快;急诊ERCP治疗组的并发症率为5·7%、转手术率是3·6%、病死率1·4%,均低于药物治疗组(其并发症率29·8%,转手术率15·4%,病死率7·3%),P<0·05,平均住院日和费用也低于药物治疗组。结论以胆源性为主因的SAP,施行急诊ERCP介入治疗是救治SAP有效的微创诊治措施,急诊ERCP介入治疗在临床疗效、住院时间及费用等均优于单纯内科药物治疗。

The curative effect of urgent therapeutic endoscopic retrograde cholangiopancereatography (ERCP) on severe acute biliary pancreatitis

Objective To study the diagnostic value and remedial effects of urgent therapeutic endoscopic retrograde cholangiopancreatography(ERCP) on severe acute biliary pencreatitis(SAP). Methods From February 2002 to July 2006, 264 cases of SAP were divided into two groups in random. The urgent therapeutic ERCP group was 140 cases treated with endoscopy and medications and the control group was 124 cases in treated with medications alone. After admission,all patients were treated with comprehensively medical management including fact to decrease pancreatic recretion,nasogastic drainage,antacid,somatostation,antibiotics,and herb medicine.In addition,endoscopic spbincteretomy (EST), endoscopic naso-choledochal or nasopancreetic duct drainage,and choledocholithotomy as well were performed within 72hr after onset in patients of ERCP group. The basket was used to extract the stones after EST in the cases suspected with stones in the common bile duct. Several indexes were documented in both groups such as the remission duration of abdominal pain, the alteration of serum amylase, APACHE H scores, days of hospital stay and sum of medical care and rate of complication. Results Urgent therapeutic ERCP was successfully performed in the 137 of 140 SAP cases without X ray. Stones in the common bile duct were removed in the 74.5% cases and endoscopic nasocholedochal or nasopancreagc tubes were inserted in the 97.8% patients. APACHE li scores, average days of hospitalstay and sum of expense in the patients of the urgent therapeutic ERCP group were superior to those in the medications group. Either the late complication rate (5.7%) or surgery rate (3.6%), the death rate(1.4%) in the urgent therapeutic ERCP group were greatly lower than those in the medications group (29.8% or 15.4%,7.3%, P<0.05). Conclusions SAP is do mainly induced by biliary disease. It is concluded that urgent therapeutic ERCP used in patients with SAP are effective and micro-invasive techniques. The urgent therapeutic ERCP is also of the best choice for biliary decompression. Application of urgent therapeutic ERCP in patients with SAP improves curative effect, shortens average hospitalstay days and reduces sum of expense compared with patients treated with medications alone.