急性胰腺炎复发诱因及内镜治疗

目的 探讨急性胰腺炎(AP)复发的诱因及其内镜治疗效果.方法 杏阅2002年1月至2008年12月长海医院收治的AP患者.详细记录患者临床资料;是否行内镜逆行胰胆管造影术(ERCP)治疗、治疗方法及并发症.电话随访后根据是否AP复发将患者分为无复发组与复发组.分析两组致病因素及内镜治疗疗效.结果 804患者入组,其中无复发组512例(63.68%),复发组292例(36.32%).无复发组平均年龄52岁,复发组平均年龄44岁,相差显著(P<0.01).201例重症胰腺炎中,无复发组104例(20.31%),复发组97例(33.22%),复发组显著高于无复发组(P<0.01).无复发组并发胰腺假性囊肿46例,复发组44例,两组胰腺假性囊肿发生率差异显著(P<0.05).AP病因为胆源性、高三酰甘油血症是胰腺炎反复发作的危险因素.139例复发性AP患者行ERCP治疗,15例(5.15%)并发ERCP术后胰腺炎,1例(0.34%)出现十二指肠乳头切开后出血.成功随访内镜介入治疗的118例复发性AP患者,内镜治疗总缓解率为78.8%.结论 复发组发病年龄较小,重症急性胰腺炎发生率及胰腺假性囊肿发生率均高,胆源性及高三酰甘油血症为诱发AP复发的危险因素.内镜介入治疗对复发性AP同样有效.     

超声内镜在急性胰腺炎中的应用进展

急性胰腺炎(AP)是临床上常见的胰腺疾病,早期诊断和正确治疗AP及其并发症对缓解患者的症状及改善预后十分重要.超声内镜(EUS)对胰腺实质、胰胆管的分辨率较高,近年来EUS在AP中的应用逐渐增多,其在病因诊断、重症急性胰腺炎(SAP)的早期预测和内镜下治疗,以及预后预测和随访等方面发挥着重要的作用.该文就EUS在AP中...     

早期内镜治疗急性胆源性胰腺炎的疗效

急性胰腺炎(AP)的发病原因复杂,其中胆石症是AP发病的主要致病因素,在西方国家胆源性胰腺炎(ABP)占每年胰腺炎发病人数的34%～54%,我国一半以上的AP的诱因为胆石症〔1〕。ABP的传统治疗方法是内科综合治疗和外科手术治疗,而外科手术治疗创伤大、恢复慢,术后并发症及病死率高。近     

重症急性胰腺炎的治疗(附132例分析)

重症急性胰腺炎(SAP)系指发生器官衰竭和(或)胰腺坏死、脓肿、假性囊肿等局部并发症的急性胰腺炎.SAP病情凶险,病死率高.提高其治愈率、降低病死率是临床上的主要问题.1993年1月至2000年12月,我院收治S AP患者132例,分别行非手术及手术治疗,现总结报告如下. 　　……     

儿童胰腺炎ERCP术后并发症研究

目的分析儿童胰腺炎患者经内镜逆行胰胆管造影(endoscopic retrograde cholangiop-ancreatography, ERCP)术后高淀粉酶血症、胰腺炎及出血等并发症的发生率,探讨其安全性.方法回顾分析1997年2月～2002年2月间入住我科确诊为儿童胰腺炎并行ERCP术的27例患者的临床资料,其中急性胰腺炎(acute pancreatitis,AP)14例,慢性胰腺炎(chronic pancreatitis,CP)13例;诊断性ERCP 9例,治疗性ERCP18例.结果 27例患者ERCP术后总体并发症发生率为51.85%(14/27),其中,高淀粉酶血症发生率22.22%(6/27),术后4、24 h血清淀粉酶水平分别为(410.75±230.31) U/L、(367.25±233.90) U/L,48～72h后均恢复正常;胰腺炎发生率22.22%(6/27),均为轻型胰腺炎;乳头切开处出血、黑便发生率7.41%(2/27),均发生于胆总管结石行十二指肠乳头括约肌切开(endoscopic sphincterotomy,EST)+取石术后;诊断性ERCP组并发症的发生率低于治疗性ERCP组,但无统计学意义.结论儿童胰腺炎患者ERCP术后具有较高的并发症发生率,内镜医师于ERCP术中应高度重视,采取必要的预防措施以减少并发症的发生.     

急性胰周积液和胰腺坏死对急性胰腺炎预后的影响

目的 探讨急性胰周积液和胰腺坏死对急性胰腺炎(AP)预后的影响.方法 回顾分析2003年1月至2007年12月收治的323例AP患者早期CT影像学表现,探讨急性胰周积液、胰腺坏死程度与全身炎症反应综合征(SIRS)、胰腺感染及病死率的关系.结果 发病5 d内出现SIRS并持续2 d或以上者97例(30%),12例(3.7%)在病程中、后期出现胰腺感染;病死14例(4.3%).有急性胰周积液者142例(44.0%).单个部位发生急性胰周积液者76例,其中31例发生SIRS,病死2例;多个部位急性胰周积液者66例,发生SIRS 62例,病死11例.急性胰周积液部位数量与早期SIRS发生及病死率显著相关(P＜0.01).277例(85.8%)无胰腺坏死,均未继发胰腺感染,病死4例;46例(14.2%)有不同程度胰腺坏死.胰腺坏死面积≤30%32例,胰腺感染发生率12.5%,病死率15.6%;＞30%～≤50%7例,感染发生率42.9%,病死率28.6%;＞50%7例,感染发生率为71.4%,病死率42.9%,胰腺坏死的程度与胰腺感染的发生及病死率显著相关(P＜0.05).结论 急性胰周积液和胰腺坏死对AP预后的影响不同.急性胰周积液与病程早期SIRS的发生及病死率相关;胰腺坏死与胰腺继发感染的发生及病死率有关,坏死面积越大,越容易发生胰腺感染,病死率越高.     

急性胰腺炎994例病因与治疗分析

目的 探讨急性胰腺炎(AP)的病因及其治疗方法 的选择.方法 回顾性分析2003年1月至2007年1月瑞金医院胰腺普外科收治的994例AP患者资料,根据病因及治疗方式进行分类统计.结果 994例AP患者中,胆源性AP 825例(83.0%),酒精性AP 24例(2.41%),高脂血症性AP29例(2.92%),妊娠性AP16例(1.61%),特发性AP 71例(7.14%),外伤性4例(0.40%),两种病因以上的混合性AP 25例(2.52%).轻症急性胰腺炎(MAP)767例(77.2%),重症急性胰腺炎(SAP)227例(22.8%).总的治愈好转率91.2%,病亡87例,病死率8.8%,其中酒精性AP的病死率达37.5%,显著高于胆源性AP.对胆源性AP患者分别采用非手术治疗、内镜逆行胰胆管造影+乳头括约肌切开(ERCP+EST)、胆囊切除术+胆总管探查或ERCP术后腹腔镜下胆囊切除术及清创引流术.采用清创引流术的患者均为SAP患者,术后病死率高达25.0%,显著高于其他治疗方法 者(P＜0.01).其他3种治疗方法 间的SAP病例比及病死率均无显著差异.结论胆道因素仍是AP的首要病因.酒精性AP病情较危重,预后较差.对胆源性AP,多种治疗方法 的疗效无显著差异.     

重症急性胰腺炎诊疗现状及主要问题

急性胰腺炎(acute pancreatitis,AP)是指多种病因引起的胰酶激活,继以胰腺局部炎症反应为主要特征的疾病,病情较重者可发生全身炎症反应综合征甚至器官功能障碍.重症急性胰腺炎(severe acute pancreatitis,SAP)是伴有持续的器官功能衰竭(48 h以上)的一类.SAP起病凶险、病死率高,SAP约占AP的5%-10%,病死率却高达30%-50%.现结合国内外文献,相关指南以及我们的经验与体会对SAP的诊治情况及存在的主要问题进行综述.     

内镜逆行胰胆管造影后胰腺炎患者炎性因子和氧化应激与胰腺代谢能力的相关性研究

目的 探究内镜逆行胰胆管造影的代谢反应与胰腺功能改变的相关性。方法 择取2020年6月至2021年11月在武安市第一人民医院收治的100例实施内镜逆行胰胆管造影术患者为研究对象,患者年龄28～76岁,平均年龄57.35±8.62岁,其中男性患者67例,女性患者33岁。将其中术后74例未出现急性胰腺炎(AP)患者设为轻症急性胰腺炎组,术后26例出现急性AP患者设为重症急性胰腺炎组。使用核磁共振(NMR)光谱对血清葡萄糖、血清β-羟基丁酸和血清乙酰乙酸进行分析。通过酶联免疫吸附试验检测患者血清淀粉酶和脂肪酶浓度。通过酶联免疫吸附试验检测患者血清细胞因子浓度。通过分光荧光法测定患者血清氧化应激水平。结果 重症急性胰腺炎患者血清葡萄糖、血清β-羟基丁酸和血清乙酰乙酸较轻症急性胰腺炎组升高(P<0.05)。重症急性胰腺炎患者尿液β-羟基丁酸和乙酰乙酸水平较轻症急性胰腺炎组升高(P<0.05)。重症急性胰腺炎患者血清淀粉酶和脂肪酶浓度较轻症急性胰腺炎患者升高(P<0.05)。重症急性胰腺炎患者血清IL-6和CRP浓度较轻症急性胰腺炎组升高(P<0.05)。重症急性胰腺炎患者...     

前列腺素E1治疗急性胰腺炎32例临床观察

近年来的研究表明，胰腺血液循环障碍可诱发急性胰腺炎(AP)和促使水肿型胰腺炎发展成出血坏死型胰腺炎，而维持正常的胰腺血液供应可有效改善AP的预后。自1999年以来．我院应用前列腺素E1(PGE1)治疗AP32例，效果满意，现告如下。     

Endoscopic retrograde cholangiopancreatography should no longer be used as a diagnostic test: the case against

Endoscopic retrograde cholangiopancreatography has been used successfully in diagnosis of pancreatico-biliary diseases. Over the past decade, there have been tremendous developments in radiological technologies which have led to the emergence of new and less invasive modalities like endoscopic ultrasound and spiral computed tomography and magnetic resonance cholangiopancreatography. Understandably, the usefulness of diagnostic endoscopic retrograde cholangiopancreatography is being questioned primarily because of its potential attendant complications. Therefore, this controversial question needs to be debated in the gastroenterology community. In this article, we compare the efficacy of newer diagnostic tools with existing "gold standard" modality--endoscopic retrograde cholangiopancreatography, and put forward our arguments in favour of a continuing role for endoscopic retrograde cholangiopancreatography as a diagnostic tool in certain circumstances.     

Evaluating the role of imaging methods in the diagnosis of chronic pancreatitis

OBJECTIVE: To evaluate the role of imaging methods in the diagnosis of chronic pancreatitis (CP) in improving the accuracy of a clinical diagnosis of CP. METHODS: The results of the imaging methods used for 129 cases diagnosed as CP in Peking Union Medical College Hospital from 1991 to 2000 were retrospectively analyzed. The imaging methods included ultrasonography (US), computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasonography (EUS). RESULTS: The sensitivity of EUS and MRCP was high and was in good agreement with ERCP in the diagnosis of CP. The sensitivity of ERCP was superior to US and CT (P < 0.05). The sensitivity of US and CT for diagnosing dilation of the pancreatic duct was 59.4% and 60%, respectively, the specificity was 93.8% and 95.7%, respectively. BT‐PABA had a better correlation with ERCP in the group with severe changes of the pancreatic duct than in the mild or moderate group. The more complications of CP that were present, the more severe the lesions of the pancreatic duct. CONCLUSION: Among the traditional imaging modalities for diagnosing CP, ERCP is the most sensitive. MRCP and EUS, the promising and novel examination techniques, have high sensitivity and good agreement with ERCP.     

ANALYSIS OF PLASTIC STENTS IN THE TREATMENT OF LARGE COMMON BILE DUCT STONES IN 45 PATIENTS

Background: Although endoscopic plastic biliary stenting is a clinical procedure routinely carried out in patients with common bile duct stones, the effects of stenting on the sizes or fragmentation of large common bile duct stones have not been formally established and the mechanism of this condition is controversial. We compared the stone sizes of common bile duct stones after biliary stenting in order to develop the mechanism. Patients and Methods: Endoscopic plastic biliary stenting was performed in 45 patients with large common bile duct stones or those difficult to extract with conventional endoscopic therapy, including mechanical lithotripsy. The stone diameter was ≥16 mm in all patients. Bile duct drainage and endoscopic placement of 7–8.5 Fr plastic biliary stents were established in all patients. Differences of stone sizes and fragmentations after biliary stenting were compared. The complete stone clearance rate after treatment was obtained. Results: After biliary stenting for 3–6 months, the bile stones disappeared or changed to sludge in 10 (10/45) patients, and fragmentation of the stones or decreased stone sizes were seen in 33 patients, whose stone median size was significantly decreased from 23.1 mm to 15.4 mm in 33 patients (P < 0.05). The stones were removed successfully with basket, balloon, mechanical lithotripsy or a combination in 43 (43/45) patients. The remaining two patients (2/45) demonstrated no significant changes in stone sizes. Conclusion: Plastic biliary stenting may fragment common bile duct stones and decrease stone sizes. This is an effective and feasible method to clear large or difficult common bile duct stones.     

EUS in exploring the etiology of mild acute biliary pancreatitis with a negative finding of biliary origin by conventional radiological methods

Background and Aim: Conventional radiological methods, including transcutaneous ultrasonography (US), computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP) are non‐invasive and recommended for the detection of etiologies of acute biliary pancreatitis (ABP). There are still, however, a number of patients whose etiologies cannot be found by these methods. The value of endoscopic ultrasound (EUS) for this population is still unknown. The aim of the present study was to evaluate the role of EUS in exploring the unknown etiology of mild ABP. Methods: The data from patients with mild ABP admitted to Changhai Hospital, Shanghai, China, from June 2006 to December 2009 were retrospectively collected, and the results of the imaging methods in detecting biliary disorders were analyzed. Results: A total of 223 patients with mild ABP underwent both US and CT. Of these, 106 underwent additional MRCP. There were still 37 patients with unknown biliary etiologies, even after the use of the conventional methods mentioned earlier. EUS was conducted in 33 of these patients. Abnormalities associated with the etiology of mild ABP were found in 14 cases (42.4%) confirmed by subsequent endoscopic retrograde cholangiopancreatography, with biliary stones in 11 cases, biliary sludge in two cases, and ampullary adenocarcinoma in one case. Conclusion: The results suggest that EUS is helpful in the identification of the etiology of mild biliary pancreatitis when conventional radiological imaging is negative or equivocal.     

Prospective study of diagnostic value of magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography in cholangiopancreatic diseases

OBJECTIVE: To compare the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) versus endoscopic retrograde cholangiopancreato­graphy (ERCP) in the detection of cholangiopan­creatic diseases via a prospective study. METHODS: Magnetic resonance cholangiopancreatography was performed in 63 patients with suspected cholangiopancreatic diseases and followed by ERCP within 24 h. The MRCP and ERCP images were analyzed and compared. RESULTS: Of the 63 patients studied, 56 (88.9%) were correctly diagnosed by using ERCP and seven (11.1%) by using percutaneous transhepatic cholangio­graphy (PTC); however, all these patients were successfully diagnosed by using MRCP. Cholangio­pancreatic diseases were diagnosed by MRCP with a sensitivity of 98.2%, a specificity of 83.3%, a misdiagnostic rate of 16.7% and a missed diagnostic rate of 1.8%. The total concordance rate of MRCP, ERCP and PTC was 85.7%. For specific conditions, the concordance rates were as follows: biliary calculi 100%; tumors of the bile duct 92.9%; papillary lesions 70.6%; hepatic distomiasis 66.7%; chronic pancreatitis 100%. The complications associated with ERCP were five cases of acute pancreatitis and one case of perinephric abscess. The patient with perinephric abscess had previously had a B‐II operation. The complication rate associated with ERCP was 9.5% (6/63), but no complications were associated with MRCP. CONCLUSION: We conclude that MRCP is as effective as ERCP for the diagnosis of bile duct lesions, such as biliary calculi and tumors, but not for papillary lesions and liver fluke infections. Although MRCP can be used in patients who can’t tolerate ERCP or when there are contraindications to using ERCP, it should not be used for therapeutic purposes.     

Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones

BACKGROUND AND AIMS: Endoscopic retrograde cholangiopancreatography is commonly performed to remove bile duct stones. The aim of this study was to determine short-term outcomes of endoscopic balloon dilation of the sphincter of Oddi compared with sphincterotomy for stone extraction. METHODS: A randomized, controlled multicenter study of 117 patients assigned to dilation and 120 to sphincterotomy was performed in a spectrum of clinical and academic practices. RESULTS: Characteristics of the patients, procedures, and endoscopists were similar except that dilation patients were younger. Procedures were successful in 97.4% and 92.5% of the dilation and sphincterotomy patients, respectively. Overall morbidity occurred in 17.9% and 3.3% ( P < .001; difference, 14.6; 95% confidence interval, 7-22.3) and severe morbidity, including 2 deaths, in 6.8% and 0%( P < .004; difference, 6.8; 95% confidence interval, 2.3-11.4) for dilation and sphincterotomy, respectively. Complications for dilation and sphincterotomy, respectively, included: pancreatitis, 15.4% and .8% ( P < .001; difference, 14.6; 95% confidence interval, 7.8-21.3); cystic duct fistula, 1.7% and 0%; cholangitis, .9% and .8%; perforation, 0% and .8%; and cholecystitis, 0% and .8%. There were 2 deaths (1.7%) due to pancreatitis following dilation and none with sphincterotomy. The study was terminated at the first interim analysis. Dilation patients required significantly more invasive procedures, longer hospital stays, and longer time off from normal activities. CONCLUSIONS: In a broad spectrum of patients and practices, endoscopic balloon dilation compared with sphincterotomy for biliary stone extraction is associated with increased short-term morbidity rates and death due to pancreatitis. Balloon dilation of the sphincter of Oddi for stone extraction should be avoided in routine practice.     

The outcome of patients with an extrahepatic biliary stricture secondary to chronic pancreatitis

Twenty-three chronic pancreatitis patients with abnormal liver function or cholangitis were shown at endoscopic retrograde cholangiopancreatography (ERCP) to have common bile duct strictures. Nine were investigated following a single episode of jaundice, 9 after multiple attacks, and 5 presented with an elevated alkaline phosphatase. Jaundice resolved spontaneously in 7 of the 9 patients presenting with a single episode. Fifteen patients required surgery: this was for recurrent or unremitting jaundice in eight, cholangitis in three, unmanageable pain in two, and radiological appearances suspicious of malignancy in two. Five had biliary bypass alone, seven underwent pancreatic resection, one had a pancreatico-jejunostomy, and two, drainage of a pseudocyst. There was one postoperative death following total pancreatectomy. The incidence of continuing pain and insulin-dependent diabetes was similar in the patients treated by biliary bypass or by pancreatic resection; one patient with a bypass had further cholangitis and two with pancreatic resection developed unmanageable steatorrhoea. The radiological severity of pancreatitis in the patients treated conservatively was similar to that in those requiring surgery. The latter group tended to have a shorter stricture of the distal common bile duct. Chronic pancreatitis patients with abnormal liver function resulting from bile duct stricture should first be managed conservatively. When surgical decompression is indicated, drainage of the pseudocyst or a simple bypass is advisable, rather than more radical measures.