急性胰腺炎复发病例的临床研究

目的：研究急性胰腺炎复发的基本病因及影像学特点。方法：回顾性分析５６例急性胰腺炎复发（复发组）及６１例初发胰腺炎（对照组）病人的基本病因、Ｂ超、ＣＴ和ＥＲＣＰ检查的变化规律以探讨其病因。结果：复发组病人胆石症发病率为６０．７％，显著高于对照组的３１．１％（Ｐ＜０．０１）；对照组发病原因不明者达５０．８％，显著高于复发组（Ｐ＜０．０１）。复发组病人中放射痛、腹肌紧张和黄疸的发生率分别为４８．２％、２１．４％和１６．１％，显著高于对照组（Ｐ＜０．０５）。Ｂ超检查发现，复发组胰腺回声粗强者达３５．７％，胰管扩张者达１９．６％，均显著高于对照组；胆囊炎、胆结石和胆总管扩张的发病率也显著高于对照组。ＣＴ示复发组胰腺假性囊肿、肿大、坏死的发生率高于对照组，但无统计学意义。ＥＲＣＰ示复发组胆总管结石、扩张的发生率显著高于对照组（Ｐ＜０．０１）；主胰管结石、扩张、狭窄及乳头部病变发生率也明显增多。结论：胆囊炎、胆囊结石、胆总管结石等疾病可能是急性胰腺炎复发的主要病因。其他还有一部分病人是慢性胰腺炎的急性发作。

Clinical Research of Acute Pancreatitis with Recurrence

Objective: To explore the etiology and changes in imaging of cases of acute pancreatitis with recurrence. Methods: Fifty-six patients suffering from acute pancreatitis with recurrence(recurrent group) and 61 patients with incipient acute pancreatitis(control group), were analyzed as to results in BUS, CT, ERCP. Re-sults: The incidence of cholelithiasis was 60.7% in the recurrent group, while it was 31.1% in the control group(P<0.01). 50.8% of the control group had no definite etiology higher than that in the recurrent group(P<0.01). The incidence of referred pain, abdominal rigidity and jaundice were 48.2%, 21.4% and 16.1% respectively in the recurrent group, much higher than that of the control group. BUS examination showed that 35.7% patients of the recurrent group had irregular echo of the pancreas, 19.6% with dilation of the pancreatic duct, and the cholecystitis, cholecystolithiasis, choledochus dilation, all much higher than those in the control group. CT examination indicated that the incidence of pancreatic pseudocyst, swelling, necrosis were higher in the recurrent group than those in the control group, but statistically insignificant. ERCP demonstrated that the incidence of choledocholithiasis, choledochus dilation (P<0.01), and pancreatic duct lithiasis, dilation or stenosis and papillary diseases were also higher in the recurrent group. Conclusions: Pancreatic and biliary diseases might be regarded as the main causative factor of acute pancreatitis with recurrence.