胆石性胰腺炎的实验室诊断

目的验证生化检测在胆石性胰腺炎诊断中的价值.方法总结北京协和医院1993年1月～1999年12月182例急性胰腺炎患者,进行回顾性病例对照分析.将性别,年龄,血清谷丙转氨酶(ALT)、总胆红素(TBIL)和血淀粉酶作为研究变量,数据输入SPSS软件包进行χ2检验,ROC曲线分析.结果当女性,年龄≥50岁,ALT≥100 U/L,TBIL≥2.3 mg/dl时,存在显著的统计学差异.ALT≥100 U/L时,诊断胆石性胰腺炎的敏感性和特异性分别为47.8%和94.1%,阳性预测值为93%.TBIL≥2.3 mg/dl时,诊断胆石性胰腺炎的敏感性和特异性分别为60%和82.4%,阳性预测值为81%.结论实验室生化检查有助于急性胰腺炎病因的诊断,对于血清ALT≥100 U/L,TBIL≥2.3mg/dl,应考虑到急性胆石性胰腺炎的可能.     

微胆石性胰腺炎

炎为结石嵌顿在壶腹部,之后较多文献相继报告结石性胰腺炎,认为结石移动被嵌顿在壶腹部是造成胰腺炎的重要原因。当患急性胰腺炎时,进行大便筛选亦发现有结石存在。为了解胆道结石移动造成急性胰腺炎之     

急性胆石性胰腺炎内镜治疗体会

1997年 5月～ 2 0 0 0年 10月 ,我们对 2 8例急性胆石性胰腺炎 (Ａｃｕｔｅｇａｌｌｓｔｏｎｅｐａｎｃｒｅａｔｉｔｉｓ,ＡＧＰ)患者进行了内镜逆行胰胆管造影 (Ｅｎｄｏｓｃｏｐｉｃｒｅｔｒｏｇｒａｄｅｃｈｏｌａｎｇｉｏｐａｎｃｒｅａｔｏｇｒａｐｈｙ ,ＥＲＣＰ)检查 ,并进行了经鼻胆管引流 (Ｅｎｄｏｓｃｏｐｉｃｎａｓｏ ｂｉｌｌａｄｒａｉｎａｇｅ ,ＥＮＢＤ)及经内镜乳头括约肌切开术 (Ｅｎｄｏｓｃｏｐｉｃｓｐｈｉｎｃｔｅｒｏｔｏｍｙ ,ＥＳＴ)等内镜治疗 ,取得了较好的临床疗效。1　资料和方法1.1　一般资料　本组 2 8例中…     

刍议胆石性胰腺炎手术治疗的临床注意要点

目的探讨胆石性胰腺炎手术治疗的临床注意要点。方法对80例胆石性胰腺炎患者临床资料进行回顾性分析,将所得资料进行分析后总结胆石性胰腺炎手术治疗注意事项。结果 80例胆石性胰腺炎患者大多实施胆囊切除+胆总管切开取石+T管引流手术治疗(46.25%);95.00%患者经对症治疗后痊愈出院,死亡率仅为5.00%,对比结果具有统计学意义(P<0.05)。结论临床医师应在术前对患者进行详细检查及评估,根据其病情实时给予针对性的手术治疗方案,从而保障患者手术疗效及预后,降低其术后并发症及复发率,确保患者生活质量及生命安全。     

胆管结石的大小及嵌顿部位与胆石性胰腺炎的关系

自１９８４年１０月至１９９６年５月,我院对１８５例因胆管结石嵌顿而引发的急性胆管炎和／或急性胰腺炎,通过内镜进行了详细的观察和治疗,发现结石的大小及其在胆管内嵌顿部位与急性胰腺炎的发生以及严重程度有密切关系,现报告如下。资料和方法一、一般资料：本组１...     

急性胰腺炎实验室诊断研究进展

急性胰腺炎是临床常见病,由于其临床表现复杂,发病机制至今未完全阐明,导致临床早期诊断极为困难。近年来出现不少实验室诊断标记物,对急性胰腺炎的早期诊断和严重度评估有极大的帮助。     

胆石性胰腺炎的一种简易临床分型法

目的 探讨胆石性胰腺炎合理的临床分型方法,以更好地指导临床选择治疗方案.方法 依据胰腺炎的病情严重程度和胆管有无梗阻,将273例胆石性胰腺炎分成4个临床类型:非梗阻性轻型(Ⅰ型)、梗阻性轻型(Ⅱ型)、梗阻性重型(Ⅲ)、非梗阻性重型(Ⅳ型);再依据胆总管内是否存在结石,将每一类型分成a、b两个亚型.然后对临床分型结果、治疗方法、预后进行分析.结果 Ⅰa型34例,Ⅰb型112例;Ⅱa型59例,Ⅱb型11例;Ⅲa型6例,Ⅲb型4例;Ⅳa型3例,Ⅳb型44例.全组总病死率为3.3%(9/273),Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型的病死率分别为0、0、10%(1/10)、17.0%(8/47),组间差别具有统计学意义(P<0.05).早期手术、传统非手术以及早期区域动脉灌注治疗Ⅳ型的病死率分别为30.8%(4/13)、25%(3/12)、4.5%(1/22),区域动脉灌注组病死率显著低于其他两组(P<0.05).结论 4型2分法是一种较为合理的胆石性胰腺炎临床分型法.以临床分型为依据细化胆石性胰腺炎治疗原则,可提高临床疗效.但在治疗过程中还需重视临床类型的转变.     

胆石性胰腺炎治疗及手术时机的选择

自l本世纪韧Opie首次揭示胆石与胰腺炎关系之后，这方面的临床资料不断积累．胆道结石作为胰腺炎的重要原因之一，基本上得到确认。但对胆石性胰腺发病理机制的了解仍较局限，胆石性胰腺病的治疗仍存在分歧。因此．作在上海第一人民医院学习期间，回顾性的收集近几年收治的67例资料进行总结分析．探讨胆石性胰腺炎的治疗和手术时机。     

重症急性胰腺炎的实验室和影像学诊断

根据患者的病史、症状、体征以及血、尿淀粉酶测定不难诊断急性胰腺炎。但重症急性胰腺炎常伴有脏器衰竭和全身或局部并发症,如弥散性血管内凝血（DIC）、严重代谢紊乱、胰腺坏死、脓肿和假性囊肿等,病情凶险,死亡率高,故早期识别重症急性胰腺炎具有重要临床意义。     

慢性胰腺炎的实验室诊断

慢性胰腺炎的实验室检查包括胰腺外分泌功能检查和胰腺内分泌功能检查,其中对胰腺外分泌功能检查的研究最为广泛、深入［１］。胰腺外分泌功能检查可分为直接试验和间接试验两类：直接试验系利用胃肠激素直接刺激胰腺分泌,如胰泌素试验（ｓｅｃｒｅｔｉｎ ｔｅｓｔ）;间接试验则是利用试验餐等方法刺激胃肠激素分泌,进而刺激胰腺分泌,如Ｌｕｎｄｈ标准餐试验、无管法胰功能试验等。两者均通过测定胰液和胰酶的分泌量,或测定胰酶消化底物的生成量,以评估胰腺分泌胰酶的能力,从而判定胰腺外分泌功能。 迄今,胰泌素试验仍是评价胰腺外…     

Prediction of bile duct stones and complications in gallstone pancreatitis using early laboratory trends

OBJECTIVES: We aimed to determine whether early trends in the serum pancreatic enzymes and liver tests of patients with gallstone pancreatitis predict persistent common bile duct (CBD) stones and complications. METHODS: Medical records of patients with gallstone pancreatitis were reviewed retrospectively. Serial serum pancreatic enzymes and liver tests were recorded until the time of cholangiography. Laboratory trends were analyzed by comparing initial results obtained in the emergency department to subsequent results obtained 8-24 h, 24-48 h, and 48-72 h after presentation. RESULTS: Of 154 patients with gallstone pancreatitis, 28 (18%) had persistent CBD stones at cholangiography. Complications and death were more frequent in patients with persistent CBD stones than in those without CBD stones (29% and 11% vs 12% and 1%, respectively; p < 0.05). Laboratory trends predicted both persistent CBD stones and complications of pancreatitis. When any laboratory value rose between admission and 24-48 h of hospitalization, persistent CBD stones were present in 31% of cases, versus 8% of those in whom all laboratory values remained constant or fell (p = 0.001). Likewise, complications occurred in 21% of those with any rising laboratory value, versus 8% of those in whom all values remained constant or fell (p < 0.05). CONCLUSIONS: Patients with gallstone pancreatitis and rising serum chemistries had a 4-fold risk of persistent CBD stones and a nearly 3-fold risk of complications compared to patients in whom all chemistry values remained constant or fell. This simple prediction rule may identify patients with biliary pancreatitis who are most likely to benefit from early interventions to diagnose and remove persistent CBD stones.     

Early endoscopic sphincterotomy in the management of acute gallstone pancreatitis in elderly patients

Eighteen elderly patients with acute attacks of gallstone pancreatitis underwent early endoscopic sphincterotomy of the papilla of Vater. Eleven patients were considered to be at high risk for surgery due to chronic cardiorespiratory or renal problems. The outcome of these patients was compared with that of 20 consecutive elderly patients with gallstone pancreatitis treated at the same time by means other than endoscopic sphincterotomy. Endoscopic sphincterotomy resulted in an immediate clinical improvement in all patients, except in one patient who developed transient cholangitis; there was no mortality. In contrast, there was one death (5%) and 20% morbidity in the controls. Mean hospitalization period was shorter in patients undergoing sphincterotomy (6 compared with 9.5 days), although the patients managed by sphincterotomy were initially more seriously ill than controls. Only two of the 11 high-risk patients underwent elective cholecystectomy; all others were well during a mean follow-up of 22 months. It is concluded that early endoscopic sphincterotomy is highly effective and safe in acute attacks of gallstone pancreatitis in elderly high-risk patients.     

Early jejunal nutrition and changes in the immunological parameters of patients with acute pancreatitis.

BACKGROUND/AIMS: We have compared the effects of glutamine-rich Stresson Multi Fibre and of Nutrison Fibre nutrients on the changes of some immunological parameters of 16 patients with acute pancreatitis. Laboratory parameters included: total protein, albumin, prealbumin, retinol binding protein, IgG, IgA, IgM, IgE, complement components: C3, C4, acute phase proteins: C-reactive protein, transferrin, CD-markers of peripheral lymphocytes and activity of peripheral phagocytes. METHODOLOGY: Nine patients were supplied with Stresson Multi Fibre and 7 patients with Nutrison Fibre, using a nasojejunal tube. The levels of serum proteins were measured with laser nephelometry, the CD markers of lymphocytes with flow cytometry and the phagocytic activity with chemiluminescence. RESULTS: The treatment with glutamine-rich Stresson resulted in significant elevations in the serum levels of IgG, retinol binding protein, compared to the effects of Nutrison Fibre. In addition, the recovery of treated patients was significantly shorter in the Stresson Multi Fibre group than in the Nutrison Fibre group. CONCLUSIONS: The Stresson Multi Fibre nutrient treatment of patients treated for acute pancreatitis seems to have clinical benefit based upon the fast recovery of IgG, IgM proteins which take part in the immunological defense mechanisms.     

65例急性梗阻型胆源性胰腺炎外科治疗分析

目的 探讨急性梗阻型胆源性胰腺炎(AOGP)外科治疗的有关问题.方法 对65例梗阻型AGP患者的临床资料进行回顾性分析,轻症急性梗阻型胆源性胰腺炎(MAOGP)42例,保守治疗38例,急诊后期手术4例;重症急性梗阻性胆源性胰腺炎(SAOGP)23例,均行早期或急诊手术.结果 本组病例痊愈64例, 1例因伴心脏病、糖尿病、多器官功能衰竭及腹腔感染术后2周内死亡.结论 对伴有化脓性胆管炎的AOGP者早期宜行急诊手术,轻型梗阻性AGP早期积极非手术治疗,胰腺炎治愈后2～4周内择期手术治疗胆石病,可以降低复发率、并发症发生率和病死率.     

Diagnostic value of various laboratory parameters in acute pancreatitis]

In 427 samples of serum and urine, collected during their stay at hospital from 40 patients affected with acute pancreatitis, the sensitivity and the specifity of total amylase and lipase in serum, total amylase and pancreas isoamylase in urine, as well as the amylase-/creatinine clearance were determined. The pancreas isoamylase in serum was used as reference value. It appeared that the sensitivity of the lipase was next to that of the pancreas isoamylase in serum, even in limit ranges. Usually the lipase stayed pathological the longest and could therefore be used to identify in the best way even an easing-off pancreatitis. The diagnostic accuracy of the total amylase in serum and urine, of the pancreatic isoamylase in urine and of the amylase-/creatinine clearance was found to be obviously less reliable. The specifity of all examined tests was reduced in patients with renal insufficiency, liver disease, alcohol abuse and in patients with abdominal pains of non pancreatic origin. Concluding form our results and with regard to the expenditure of laboratory technique and to the time required by the methods of determination, we found that of all the examined parameters, the lipase was the most convenient for both emergency and routine diagnose of an acute pancreatitis.     

Factors associated with prior acute pancreatitis episodes among patients with chronic pancreatitis

BackgroundThe relationship between chronic pancreatitis (CP) and acute pancreatitis (AP) is complex and not well understood. CP could be preceded by antecedent episodes of AP.AimsThe aim of this study was to explore both genetic and environmental factors associated with AP episodes before the diagnosis of CP.MethodsThis was a cross-sectional study including 1022 patients. Detailed demographic, genetic, and clinical data were collected. Based on the presence of AP episode(s) before diagnosis of CP, patients were divided into AP group (further classified into single episode of AP group and recurrent AP group) and non-AP group. Related factors among these groups were assessed using multivariate logistic regression model.ResultsBefore diagnosis of CP, 737 patients (72.1%) had a history of AP. Smoking(P = 0.005) and heavy alcohol consumption(P = 0.002) were risk factors for AP while age at CP onset(P < 0.001), harboring the SPINK1 mutation(P < 0.001), diabetes(P < 0.001) and steatorrhea(P < 0.001) were protective factors. Further, alcoholic CP(P = 0.019) was the only independent risk factor for recurrent AP attacks while age at onset of CP(P < 0.001), pancreatic stones(P = 0.024). and pseudocysts(P = 0.018) served as protective factors.ConclusionsSPINK1 mutations served as protective factor for AP episodes, suggesting SPINK1 mutation might play a pathogenic role in CP occurrence with occult clinical manifestations.     

影响重症胰腺炎预后的早期危险因素分析

目的探讨影响重症急性胰腺炎（severe acute pancreatitis,SAP）预后的早期危险因素。方法回顾性分析2000年1月至2010年12月间我院收治的SAP患者90例,按预后分为死亡组（37例）和生存组（53例）。分析比较两组患者临床资料及人院24h内实验室检查指标的差异,并通过Logistic回归分析筛选与预后有关的危险因素。结果死亡组患者年龄、血糖显著高于生存组（JP〈0．05）。死亡组患者动脉血氧分压、血钙、血清白蛋白显著低于生存组（P〈0．05）。高龄（OR=1．589．95％CI：1．195～2．114,P〈0．05）,动脉血氧分压（OR=0．055,95％CI：0．004—0．700,P〈0．05）、血清白蛋白（OR=0．850,95％CI：0．752～0．960,P〈0．05）是影响SAP预后的早期因素。结论高龄、低动脉血氧分压、低血清白蛋白可能是影响SAP预后的早期危险因素。