Late results of endoscopic papillosphincterotomy treatment in patients with acute cholecystitis

The authors examined 81 patients who were subjected to endoscopic papillosphincterotomy (EPST) in the management of acute cholecystitis attended by total or partial obstruction of the choledochus. Cholestomy was carried out before or after EPST in 68 patients but not in 13 patients. The duration of the follow-up period after treatment ranges from 12 months to 6 years. All patients who were examined felt well and had no complaints caused by cholelithiasis. It was found that destruction of the sphincter apparatus of the major duodenal papilla and terminal choledochus led to the development of reflux from the duodenum into the choledochus in 25% of cases. In 18 patients ultrasonic examination revealed signs of chronic pancreatitis which was not manifested clinically. Among 13 patients with a preserved gallbladder containing concrements only 3 were operated on during the follow-up period. Residual choledocholithiasis was found in 5 patients in whom during good bile drainage after EPST it was not manifested clinically. The authors come to the conclusion that EPST shows a high clinical efficacy in the treatment of acute cholecystitis complicated by obstruction of the terminal choledochus.     

早期内镜介入干预对急性胆源性胰腺炎的价值

目的 探讨急性胆源性胰腺炎早期内镜治疗的疗效及安全性.方法 将2001年1月至2012年1月本院收治的420例急性胆源性胰腺炎按治疗方式随机分为早期(48 h内)内镜下逆行胆胰管造影治疗组(ERCP组)218例及同期保守治疗组(对照组)202例.分别观察两组的腹痛缓解时间、血尿淀粉酶恢复时间、肝功能恢复时间、血白细胞计数恢复时间、平均住院天数、平均费用并观察其并发症发生情况.结果 ERCP组全部成功施行内镜下乳头括约肌切开,172例胆总管结石患者行网篮及气囊取石,218例均行内镜鼻胆管引流术,重症20例同时行胰管支架引流.ERCP组平均腹痛缓解时间及血尿淀粉酶恢复时间、肝功能恢复时间、血白细胞恢复时间、平均住院天数、平均费用均明显低于对照组.ERCP组重症病死率为8.0％,对照组重症患者病死率22.2％.结论 急性胆源性胰腺炎早期施行ERCP能够明确病因,疗效确切安全,能缩短住院时间及减少住院费用.     

急性胆源性胰腺炎内镜治疗的临床分析

急性胆源性胰腺炎(acute biliary pancreatitis,ABP)是指由胆道疾病(结石、蛔虫、乳头狭窄等)诱发的急性胰腺炎(acute pancreatitis,AP).主要机制是因胰胆管排空不畅和压力升高,胆汁向胰管反流,从而引起AP,结石是该病的主要原因[1].内镜因其在胆道系统的独特优势,现已广泛应用于急性胆源性胰腺炎的治疗并取得了满意的疗效.安徽省立医院自1999年8月至2006年12月共行ERCP(逆行胰胆管造影)1719例,近二年应用该技术治疗急性胆源性胰腺炎42例,现将治疗情况总结如下.     

内镜治疗急性胆源性胰腺炎的疗效评价

目的　探讨内镜治疗急性胆源性胰腺炎的临床效果。方法　将 3 6例急性胆源性胰腺炎患者分成两组治疗 ,其中 2 0例于 2 4h内行逆行胰胆管造影术 (ERCP )、内镜下乳头括约肌切开 (EST )后用网篮取石或碎石网篮碎石后气囊取石术及内镜下鼻胆管引流术 (内镜治疗组 ) ;另 16例行保守或急诊外科手术治疗 (对照组 )。结果　内镜组治疗的成功率为 95 .2 4% ,未发生与内镜操作有关的严重并发症 ,与对照组相比 ,内镜组术后腹痛缓解时间、住院时间明显低于对照组 (P <0 .0 1) ,术后第 2天血及尿淀粉酶明显降低 (P <0 .0 5 ) ,第 3天降低更为明显 (P <0 .0 1)。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 ,通畅了胆胰液的引流 ,降低胆胰管内压 ,可有效治疗胆源性胰腺炎 ,该方法微创、安全、有效 ,是治疗急性胆源性胰腺炎的理想方法。     

Use of glucagon in the treatment of acute pancreatitis]

Personal experience with glucagon in 15 cases of acute pancreatitis is reported. Complete remission of pain within 2-3 hr after infusion of the drug was noted in 85% of the series, together with normalisation of blood amylase within 48-72 hr. Glucagon inhibits pancreatic secretio&n. Vairous theories concerning its mechanism of action are examined.     

Use of ribonuclease in multimodal treatment of acute pancreatitis

The method of intraductal administration of ribonuclease as a therapeutic measure was developed on an experimental model of acute pancreatitis in albino rats. Morphological and biochemical examination showed that intraductal administration of ribonuclease in a dose of 0.5 mg produces a positive therapeutic effect, which allowed the method to be applied in complex treatment of 33 patients with various forms of acute pancreatitis. Administration of ribonuclease into the pancreatic duct relieved the attack of pain and reduced the level of lipo- and proteolytic enzymes in blood. No complications were encountered in endoscopic cannulation of the main pancreatic duct and subsequent administration of ribonuclease.     

Use of dibunol and delagil in the treatment of acute pancreatitis

The effect of Dibunol and Delagil on the course of experimental pancreatitis was studied in experiments in 80 rats and 36 dogs. The intravenous injection of the drugs was shown to decrease lethality of the animals. Control of biochemical parameters has revealed decreased activity of amylase, lipase, trypsin and malonic dialdehyde, normalized level of superlight luminescence of blood plasma. A good medical effect was obtained in 15 patients with acute pancreatitis.     

Surgical and endoscopic papillosphincterotomy in surgery of the bile ducts

Surgical transduodenal papillosphincterotomy (TPS) on 119 patients was compared with endoscopic papillosphincterotomy (EPS) on 507 patients for rate of success and directly related complications. No major differences were found to exist between both approaches with regard to frequency or pathologico-anatomic nature of complications. Satisfactory experience has been obtained by the authors primarily from EPS on patients in advanced age or high-risk patients with choledocholithiasis following cholecystectomy (n = 320), benign and malignant stenosis of Vater's papilla (n = 97), and choledocholithiasis with gall-bladder in situ (n = 94). Intervention endoscopy of bile ducts is preferred primarily for patients in advanced age or for high-risk patients.     

内镜逆行胰胆管造影术治疗急性胆源性胰腺炎的临床疗效观察

目的观察内镜逆行胰胆管造影术(ERCP)治疗急性胆源性胰腺炎的效果。方法选取2016-02—2019-02间新蔡县人民医院收治的100例急性胆源性胰腺炎患者,按照随机数字表法分为2组,各50例。对照组采用药物治疗,观察组采用ERCP术治疗。比较2组治疗前后的血清炎症因子(CRP、TNF-α、IL-6、IL-8)水平、肝功能指标(AST、ALT、GGT、TBiL)、生化指标,以及临床症状改善效果。结果治疗后观察组患者的血清炎症因子水平、肝功能指标,以及体温、肝功能、淀粉酶、白细胞计数、胃肠道功能恢复正常时间,和恶心、呕吐消失及腹痛缓解时间等指标比较,均明显优于对照组,差异均有统计学意义(P<0.05)。结论采用ERCP术治疗急性胆源性胰腺炎,能有效抑制炎症因子释放,有利于改善患者的症状和促进肝功能及生化指标的恢复,是处理急性胆源性胰腺炎的重要治疗方式。     

Use of millimeter wave therapy in treatment of acute pancreatitis

The observations were performed in 226 patients with acute destructive pancreatitis. In 152 patients the medical complex was supplemented with a program of photo-millimeter-wave therapy in which the electromagnetic radiation of the millimeter diapason combined with red and green light was used with due regard for the disease stage. The inclusion of photo-millimeter-wave therapy in the complex of treatment starting from the 2-3 days of disease promoted a decrease of the systemic inflammatory reaction, rapidly improved the general condition of the patients, reduced the occurrence of infectious forms of pancreanecrosis, lethality and time of hospital staying of the patients. The inclusion of photo-millimeter-wave therapy since the 10-15th day did not influence the duration of hospitalization but resulted in more favorable course of the disease and less lethality.     

重症急性胆源性胰腺炎早期内镜治疗的疗效分析

急性胆源性胰腺炎在临床上十分常见,占急性胰腺炎的 50%～70%[1]. 其中胆源性重症急性胰腺炎(bile severe acutepancreatitis,BSAP)起病急,病情重,发展快,死亡率高,提倡"个体化治疗方案",是临床工作中比较棘手的难题.随着内镜技术的不断发展,经内镜介入治疗已逐步应用于胆源性急性胰腺炎.     

重症急性胆源性胰腺炎早期内镜治疗的疗效分析

急性胆源性胰腺炎在临床上十分常见,占急性胰腺炎的 50%～70%[1]. 其中胆源性重症急性胰腺炎(bile severe acutepancreatitis,BSAP)起病急,病情重,发展快,死亡率高,提倡"个体化治疗方案",是临床工作中比较棘手的难题.随着内镜技术的不断发展,经内镜介入治疗已逐步应用于胆源性急性胰腺炎.     

急性胆源性胰腺炎的早期内镜治疗与保守治疗的对比分析

目的 探讨急性胆源性胰腺炎的早期内镜下逆行胰胆管造影检查和治疗与保守治疗的临床疗效及安全性.方法 64例急性胆源性胰腺炎患者,其中36例合并急性胆管炎患者采取急诊实施内镜下十二指肠乳头切开和取石术,28例采取保守治疗者为对照组.结果 36例胆源性胰腺炎合并胆管炎患者顺利实施ERCP;且较保守治疗组病情得到及时有效控制;同对照组相比所有患者均未出现严重并发症.结论 ERCP对于治疗急性胆源性胰腺炎合并急性胆管炎具有微创、安全、有效,是治疗急性胆源性合并急性胆管炎的有效方法之一.