急性胆源性胰腺炎的诊治体会

目的总结急性胆源性胰腺炎的诊治体会,以改进诊治方法.方法对110例胆源性胰腺炎的临床资料进行回顾性分析.结果 110例中83例确是胆源性胰腺炎,其中入院时胆道仍有梗阻者(梗阻型)34例,梗阻已解除者(非梗阻型)49例.其余27例不是胆源性胰腺炎,20例只是胆源性一过性胰高压,7例乃一般胰腺炎,发病与胆道无关.结论诊断胆源性胰腺炎要有根据,临床上不可凡遇胆道有结石,血或(和)尿淀粉酶升高就诊断为胆源性胰腺炎.要根据治疗前胆道有无梗阻对胆源性胰腺炎分型论治:梗阻型应尽早引流解除胆道梗阻,非梗阻型宜积极保守治疗,病情缓解后在同一住院期内手术.胆源性一过性胰高压和胰腺炎要按胆道或胰腺病情处理,不可一概按胆源性胰腺炎治疗.     

238例急性胆源性胰腺炎诊治体会

1999年1月～2006年10月,我院共收治238例急性胆源胰腺炎（AGP）患者,疗效满意。现报告如下。     

内镜诊治急性胆源性胰腺炎临床疗效分析

[目的]分析内镜诊治急性胆源性胰腺炎(ABP)的临床疗效及价值。[方法]收集确诊为胆源性胰腺炎患者90例,分为内镜治疗组36例及常规治疗组54例,比较2组临床疗效。[结果]内镜治疗组的症状缓解时间及住院天数明显少于常规治疗组,2组比较差异有统计学意义(P0.05);内镜治疗组患者术后胰腺脓肿、假性囊肿等并发症及死亡例数明显少于常规治疗组,2组比较差异有统计学意义(P0.05)。[结论]ABP早期内镜治疗可促进病情迅速改善,并减少并发症发生,疗效明显优于单纯内科治疗。     

急性胆源性胰腺炎早期内镜诊治结果报告

一部分急性胰腺炎由胆道疾病引起，过去主要采用手术治疗，随着内镜诊断及治疗技术的不断提高，急性胰腺炎特别是急性胆源性胰腺炎不再被认为是内镜治疗的禁忌证。我院2002年1月至2005年11月经内镜治疗43例急性胆源性胰腺炎，现将患者的临床资料及其治疗效果报道如下。     

胰管反流与急性胆源性胰腺炎

急性胆源性胰腺炎 (ＡＧＰ)是一种常见的疾病 ,死亡率达10 %～ 15 % [1] 。其发作可能与胰管反流有关。为此 ,我们研究ＡＧＰ与胰管反流之间的关系 ,以证实胰管反流是诱发ＡＧＰ的可能因素。资料与方法一、一般资料1994年 1月～ 1998年 12月间 16 3例胆囊结石病患者 ,曾行胆道手术 (包括胆囊切除或胆总管引流 )。其中男 48例 ,女 115例 ,年龄为 2 5～ 74岁 (平均 5 6岁 )。二、方法有ＡＧＰ(Ｂ超或ＣＴ证实 )病史者 14例 ,无ＡＧＰ病史的149例作为对照。所有患者术中经胆囊管或Ｔ管作胆总管造影。造影剂为 30 %胆影葡胺 ,当胆总管注入 10ｍ…     

经EST治疗急性胆源性胰腺炎

目的探讨经十二指肠镜下乳头肌切开(EST)治疗急性胆源性胰腺炎的疗效.方法53例急性胆源性急性胰腺炎患者分为三组1、EST治疗组13例.2、内科保守治疗组24例.3、外科手术组16例.比较三组病人的治疗效果.结果淀粉酶恢复时间内科组和EST组均较快,组间比较无差异,但内科组与手术组间比较差异显著,P＜0.01.腹痛缓解时间EST组和内科组均较早,分别与手术组间比较差异显著,P均＜0.01.EST组与内科组间比较无差异.平均住院日数EST组和内科组均较短,分别与手术组比较差异均显著,P＜0.01.EST组与内科组比较无差异.内科治疗组中有4例(4/24)于2个月、8个月胰腺炎复发.结论EST治疗急性胆源性胰腺炎具有疗效好、恢复快、安全性高并可预防胰腺炎复发等优点.     

急性胆源性胰腺炎的内镜下介入治疗

目的 :综合评价早期内镜下介入治疗急性胆源性胰腺炎的方法、疗效及并发症等。方法 :10 3例胆源性胰腺炎患者中 ,5 7例在 72h内行早期内镜下介入治疗 ,4 3例保守治疗 ,保守治疗中的 19例择期内镜检查及治疗 ,3例外科手术治疗。结果 :早期内镜治疗组 80 .70 %患者临床症状得到迅速缓解 ;保守治疗组 6 2 .79%也可迅速缓解。全部内镜治疗后 3例出现胰腺炎加重。结论 :早期内镜介入治疗对于急性胆源性胰腺炎是一种有效而安全的方法 ,对于有明显黄疸、感染、结石嵌顿的病例应急诊内镜下治疗 ;对于病情较轻、黄疸不重的患者可先保守治疗后再行择期内镜治疗     

重症急性胆源性胰腺炎内镜治疗探讨

近年来,我院将内镜下乳头括约肌切开(EST)及取石术用于急性重症胆源性胰腺炎(SABP)的病因治疗,本文对内镜治疗的时间选择及其效果进行探讨。 一、对象和方法 1.一般情况:1998年7月至2002年6月我院共收治急性重症胰腺炎73例,男46例,女27例。年龄24～80岁。死亡7例,病死率9.6％。73例急性重症胰腺炎在入院72 h     

内镜诊治急性胆源性胰腺炎的临床分析

目的：评价内镜诊治急性胆源性胰腺炎（ABP）的临床价值。方法：回顾性分析内镜治疗的114例ABP患者以及内科常规治疗的106例ABP患者的临床资料,评价内镜诊治ABP的临床价值。结果：内镜治疗组114例均顺利完成逆行胰胆管造影（ERCP）检查并确诊,其中107例同时经内镜分别进行十二指肠乳头括约肌切开、胆管取石/蛔虫/血凝块、鼻胆管引流、胆管内置管/金属支架引流等治疗,术后所有患者均治愈出院,无明显并发症发生;与常规治疗组相比内镜治疗组平均住院时间明显缩短（12.1±4.2dvs.18.7±8.9d,P〈0.05）,平均住院费用明显降低（P〈0.05）。结论：内镜治疗ABP是一项安全、有效的措施;早期ERCP检查可明确ABP的病因,同时内镜治疗可及时去除其病因。可明显缩短患者平均住院时间、降低平均住院费用。     

内镜在急性胆源性胰腺炎治疗中的临床研究

目的 探讨内镜技术治疗急性胆源性胰腺炎的临床疗效和安全性.方法 回顾性分析2007年9月至2010年9月收治的急性胆源性胰腺炎162例的临床资料,在综合治疗的基础上,按治疗方式分为内镜组(82例)和内科保守治疗组(80例).并对其临床疗效进行总结分析.结果 内镜组的治疗效果及减少并发症方面均优于内科保守治疗组(P＜0.05).结论 内镜治疗在胆源性胰腺炎的治疗中是安全可行的,严格掌握适应证和熟练的技术应用及个体化治疗显著提高了治疗有效率.     

Intraductal acidosis in acute biliary pancreatitis

Acute pancreatitis recently became the most common cause for hospitalization among gastrointestinal diseases. There is no specific therapy against the disease due to insufficient understanding of pathogenesis. Animal and in vitro models indicated that reduced pancreatic ducal bicarbonate secretion and consequent intraductal acidosis is an early event in acute pancreatitis, but human data are lacking. Therefore, our aim was to determine the luminal pH in the main pancreatic duct during acute pancreatitis in humans.Intraductal pH was measured in patients with acute biliary pancreatitis (n = 6) during endoscopic retrograde cholangio-pancreatography. Patients with common bile stones without pancreatitis (n = 5) and a patient with an adenoma of the papilla of Vater served as controls. The luminal pH was significantly lower in the group of acute biliary pancreatitis vs. controls (6.97 ± 0.13 vs. 7.79 ± 0.20).Our brief report shows for the first time that there is marked intraductal acidosis in acute biliary pancreatitis, which seems to worsen with time. Further clinical trials are needed to determine the exact roles of reduced intraductal pH in ABP.     

急性胰腺炎的发病机制和诊治进展

一、急性胰腺炎的发病机制 虽然急性胰腺炎的发病机制并未完全阐明，但是胰蛋白酶原胰腺内活化进而导致胰腺自身消化从而引发胰腺炎已经达成共识。临床上研究胰腺炎通常是比较困难的，这主要是由于以下原因：（1）由于胰腺是腹膜后位器官，所以很难通过穿刺取得病理组织；（2）通常胰腺炎的始发阶段在胰腺炎患者到达医院时已经结束。所以有关胰腺炎的发病机制在动物实验中研究较多，而且动物实验已经证实胰蛋白酶原的激活部位是胰腺腺泡，而不是间质和脂肪组织，这个发现使许多学者通过分离胰腺腺泡细胞来研究急性胰腺炎的始动过程。     

胰腺疾病患者ERCP术后并发高淀粉酶血症及急性胰腺炎临床对比研究

目的为了探讨胰腺疾病患者ＥＲＣＰ安全性。方法观察了１１７例胰腺疾病患者ＥＲＣＰ术后４小时、２４小时血清淀粉酶变化及急性胰腺炎发生情况,并与１１４例非胰腺疾病ＥＲＣＰ术后患者作了对比研究。结果１１７例胰腺疾病患者ＥＲＣＰ术后４小时、２４小时血清淀粉酶水平分别为２９２．４±３１９．６Ｕ／Ｌ及２２６．５±２６２．９Ｕ／Ｌ,明显高于术前水平（１８０．７±１０６．４Ｕ／Ｌ,Ｐ＜０．０１）,亦明显高于对照组相同时间水平（２５２．１±２３５．２及１８７．８±２１８．３Ｕ／Ｌ,Ｐ＜０．０５）,其中１０例患者发生急性胰腺炎（８．５％）,亦明显高于对照组（３．５％,Ｐ＜０．０５）。结论有胰腺疾病基础患者ＥＲＣＰ术后发生高淀粉酶血症及急性胰腺炎机率较非胰腺疾病患者明显增高,应采取必要的预防措施。     

Profile of and risk factors for early unplanned readmissions in patients with acute necrotizing pancreatitis

IntroductionAcute necrotizing pancreatitis (ANP) complicates up to 15% of acute pancreatitis cases. ANP has historically been associated with a significant risk for readmission, but there are currently no studies exploring factors that associate with risk for unplanned, early (<30-day) readmissions in this patient population.MethodsWe performed a retrospective review of all consecutive patients presenting to hospitals in the Indiana University (IU) Health system with pancreatic necrosis between December 2016 and June 2020. Patients younger than 18 years of age, without confirmed pancreatic necrosis and those that suffered in-hospital mortality were excluded. Logistic regression was performed to identify potential predictors of early readmission in this group of patients.ResultsOne hundred and sixty-two patients met study criteria. 27.7% of the cohort was readmitted within 30-days of index discharge. The median time to readmission was 10 days (IQR 5–17 days). The most frequent reason for readmission was abdominal pain (75.6%), followed by nausea and vomiting in (35.6%). Discharge to home was associated with 93% lower odds of readmission. We found no additional clinical factors that predicted early readmission.ConclusionPatients with ANP have a significant risk for early (<30 days) readmission. Direct discharge to home, rather than short or long-term rehabilitation facilities, is associated with lower odds of early readmission. Analysis was otherwise negative for independent, clinical predictors of early unplanned readmissions in ANP.     

Factors and outcomes associated with pancreatic duct disruption in patients with acute necrotizing pancreatitis

Background and aimsAcute necrotizing pancreatitis (ANP) can affect main pancreatic duct (MPD) as well as parenchyma. However, the incidence and outcomes of MPD disruption has not been well studied in the setting of ANP.MethodsThis retrospective study investigated 84 of 465 patients with ANP who underwent magnetic resonance cholangiopancreatography and/or endoscopic retrograde cholangiopancreatography. The MPD disruption group was subclassified into complete and partial disruption.ResultsMPD disruption was documented in 38% (32/84) of the ANP patients. Extensive necrosis, enlarging/refractory pancreatic fluid collections (PFCs), persistence of amylase-rich output from percutaneous drainage, and amylase-rich ascites/pleural effusion were more frequently associated with MPD disruption. Hospital stay was prolonged (mean 55 vs. 29 days) and recurrence of PFCs (41% vs. 14%) was more frequent in the MPD disruption group, although mortality did not differ between ANP patients with and without MPD disruption. Subgroup analysis between complete disruption (n = 14) and partial disruption (n = 18) revealed a more frequent association of extensive necrosis and full-thickness glandular necrosis with complete disruption. The success rate of endoscopic transpapillary pancreatic stenting across the stricture site was lower in complete disruption (20% vs. 92%). Patients with complete MPD disruption also showed a high rate of PFC recurrence (71% vs. 17%) and required surgery more often (43% vs. 6%).ConclusionsMPD disruption is not uncommon in patients with ANP with clinical suspicion on ductal disruption. Associated MPD disruption may influence morbidity, but not mortality of patients with ANP. Complete MPD disruption is often treated by surgery, whereas partial MPD disruption can be managed successfully with endoscopic transpapillary stenting and/or transmural drainage. Further prospective studies are needed to study these items.     

高脂血症性急性胰腺炎与胆源性胰腺炎的临床对比分析

目的对比分析高脂血症性急性胰腺炎（hyperlipidemic acute pancreatitis,HLAP）与急性胆源性胰腺炎（acute biliary pancreatitis,ABP）的临床特点。方法回顾性对比分析我院2005年8月～2010年8月间收治的28例HLAP和64例ABP患者的临床资料。结果 HLAP组BMI、重症患者比例、Ranson评分≥3、CT分级为D、E及APACHEII≥8分者均较ABP组高（P〈0.05）。HLAP组血清TG、GLU、UA均显著高于ABP组,而ALT、AKP、TBIL、DBIL及血AMY均显著低于ABP组（P〈0.05）。两组患者平均住院时间无统计学差异（P〉0.05）。HLAP组患者死亡率为14.3%）,显著高于ABP组的1.5%（P〈0.05）。结论与ABP组相比,HLAP组通常病情较重,多为SAP且常不伴有血淀粉酶的显著升高,且死亡率高。     

Pancreatic hemorrhage contributes to late mortality in patients with acute necrotizing pancreatitis

ObjectivesThe frequency, risk factors, and impact on survival of hemorrhage into (peri)pancreatic collections in patients with acute pancreatitis (AP) has not been well studied. The study was designed to evaluate the risk factors for hemorrhage, successful hemostasis and its effect on in-hospital mortality.MethodsIn a prospective cohort study for prediction of severity of AP, the incidence, risk factors, and outcomes of pancreatic hemorrhage were analyzed. Patients with significant hemorrhage were managed according to a predefined protocol including endovascular intervention.ResultsOut of 363 patients hospitalized during the study-period, 33(9%) patients developed hemorrhage. Median time from onset of AP to hemorrhage was 59(45–68) days. The cause of hemorrhage was arterial in 19(57.5%) patients and unlocalized in 14(42.5%) patients. Hemorrhage was managed by conservative approach in 7 (21.2%), radiographic angioembolisation in 16 (48.5%), radiographic angioembolisation followed by surgery in 3 (9.1%), and surgery in 7 (21.2%) patients. Persistent organ failure [aHR 2.3 (1.1–5.1), p = 0.03], use of large bore (>20 Fr) catheter for initial drainage [aHR 3.9 (1.7–9.1), p = 0.001] and extensive (>50%) necrosis [aHR 3.1 (1.4–6.9), p = 0.005] were significant risk factors for hemorrhage. Hemorrhage was an independent predictor of mortality [aHR 2.0 (1.2–3.4), p = 0.008] in addition to persistent organ failure (aHR 12.1 (5.7–25.8), p < 0.001). In-hospital mortality in patients with hemorrhage was 22/33 (66.7%) vs. 81/330 (25%) in no hemorrhage group [p <0.001].ConclusionPancreatic hemorrhage occurs later in the course of acute pancreatitis in relatively sicker group of patients with organ failure and extensive necrosis, and is independently associated with a higher risk of in-hospital mortality.     

Effect of endogenous cholecystokinin on the course of acute pancreatitis in rats

AIM: To examine the effects of pancreatic rest, stimulation and rest/stimulation on the natural course of recovery after acute pancreatitis. METHODS: Acute hemorrhagic pancreatitis(AP) was induced in male rats by intraductal infusion of 40 μl/100 g body weight of 3% sodium taurocholate. All rats took food ad libitum. At 24 h after induction of AP, rats were divided into four groups: control(AP-C), pancreas rest(AP-R), stimulation(AP-S), and rest/stimulation(AP-R/S). Rats in the AP-C, AP-R and AP-S groups received oral administration of 2 ml/kg body weight saline, cholecystokinin(CCK)-1 receptor antagonist, and endogenous CCK release stimulant, respectively, twice daily for 10 d, while those in the AP-R/S group received twice daily CCK-1 receptor antagonist for the first 5 d followed by twice daily CCK release stimulant for 5 d. Rats without any treatment were used as control group(Control). Biochemical andhistological changes in the pancreas, and secretory function were evaluated on day 12 at 24 h after the last treatment. RESULTS: Feeding ad libitum(AP-C) delayed biochemical, histological and functional recovery from AP. In AP-C rats, bombesin-stimulated pancreatic secretory function and HOMA-β-cell score were significantly lower than those in other groups of rats. In AP-R rats, protein per DNA ratio and pancreatic exocrine secretory function were significantly low compared with those in Control rats. In AP-S and AP-R/S rats, the above parameters recovered to the Control levels. Bombesinstimulated pancreatic exocrine response in AP-R/S rats was higher than in AP-S rats and almost returned to control levels. In the pancreas of AP-C rats, destruction of pancreatic acini, marked infiltration of inflammatory cells, and strong expression of α-smooth muscle actin, tumor necrosis factor-α and interleukin-1β were seen. Pancreatic rest reversed these histological alterations, but not atrophy of pancreatic acini and mild infiltration of inflammatory cells. In AP-S and AP-R/S rats, the pancreas showed almost normal architecture. CONCLUSION: The favorable treatment strategy for AP is to keep the pancreas at rest during an early stage followed by pancreatic stimulation by promoting endogenous CCK release.     

Role of N-13 ammonia PET/CT in diagnosing pancreatic necrosis in patients with acute pancreatitis as compared to contrast enhanced CT – Results of a pilot study

BackgroundContrast enhanced computerized tomography (CECT) is used to determine severity of acute pancreatitis based upon the presence and extent of necrosis. However limitations do exist precluding its applicability in renal failure. Positron emission tomography (PET) imaging for cardiac perfusion shows good uptake of N-13 ammonia (¹³NH₃) metabolites in pancreas owing to high perfusion.AimTo evaluate the role of ¹³NH₃ PET/CT in acute pancreatitis and compare it with CECT in diagnosing and quantifying pancreatic necrosis.Material and methodsPatients presenting within 1 week of acute pancreatitis were studied. Static PET images were acquired after intravenous injection of 370–740 MBq of ¹³NH₃. ¹³NH₃ PET/CT was followed by CECT in the absence of renal impairment. Maximum standard-uptake-value (SUVmax) of pancreas (P) and liver (L) were taken and their ratio (P/L) was estimated to determine perfusion. Areas within pancreas with no tracer uptake were considered necrotic. These patients were managed as per institutional protocol. Patients undergoing ¹³NH₃ PET/CT for coronary artery disease were used as controls.Results29 patients (72% males) were studied of whom 6 had elevated serum creatinine. ¹³NH₃ PET/CT was done in all patients along with 9 controls while CECT was carried out after PET/CT in 23 patients. Median levels of SUVmax (P/L) in the controls, uninvolved pancreas and necrotic areas were 1.0 (0.86–1.03), 0.66 (0.50–0.92) and 0.12 (0.07–0.21) respectively (p < 0.001). Necrosis estimation was similar in 22/23 patients without renal failure while in one patient only ¹³NH₃ PET/CT picked up necrosis (<30%). 5/6 patients with renal failure had necrosis on ¹³NH³ PET/CT which was confirmed on surgery or subsequent CECT after improvement of renal failure.ConclusionThis pilot study is the first in literature to diagnose necrosis in patients with acute pancreatitis using ¹³NH₃ PET/CT. With minimal additional radiation burden, it is possible to estimate the absolute tissue perfusion as well. With no adverse renal side effects, this can be an alternative to CECT in patients with renal failure giving similar information. It has good agreement with CECT with a good interobserver acceptability.