老年急性重症胆源性胰腺炎的早期内镜治疗

目的探讨早期急诊内镜治疗对老年急性重症胆源性胰腺炎的临床价值。方法确诊为急性重症胆源性胰腺炎的92例高龄患者，分成内镜组（n=43）和对照组（n=49），对其血清肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6、IL-8以及淀粉酶恢复正常时间、腹痛缓解时间、住院天数，还有并发症发生率和死亡率等指标进行比较分析。结果治疗7d后内镜组患者血清TNF-α、IL-6、IL-8和对照组比较下降更明显，差异有统计学意义（45．16±13．48）μg／L比（176．89±47．35）μg／L、（31．76±13．85）μg／L比（68．48±24．87）μg／L、（113．39±63．78）μg／L比（309．86±117．13）μg／L，P均〈0．05]；内镜组患者腹痛缓解时间、淀粉酶恢复正常时间、住院时间明显短于对照组（10．2±1．7）d比（13．2±2．4）d、（3．3±1．0）d比（5．5±1．2）d、（15±1．6）d比（20±3．0）d，P均〈0．05]；并发症发生率也低于对照组（5％比22％，P〈0．05）。结论早期内镜介入治疗老年急性重症胆源性胰腺炎具有微创、安全、有效的优点，能明显缓解病情的进一步发展。

Early endoscopic therapy for elderly patients with acute severe biliary pancreatitis

Objective To evaluate the clinical effects of early endoscopic therapy for elderly patients with acute severe biliary pancreatitis.Methods Ninety-two elderly patients with acute severe biliary pancreatitis were randomly divided into 2 groups:ERCP group ( n =43) and non-ERCP group ( n =49).Serum TNF-a,IL-6,IL-8,the recovery time of blood amylase,the duration of abdominal pain,hospitalization,mortality and complications were compared.Results ERCP group showed a greater decrease in serum TNF-α,IL-6 and IL-8 levels than the control group ( 45.16 ± 13.48 ) μg/L v.s.( 176.89 ± 47.35 ) μg/L,(31.76 ± 13.85)μg/L v.s.(68.48 ±24.87) μg/L,(113.39 ±63.78) μg/L v.s.(309.86 ± 117.13)μg/L) (P ＜0.05 ).The duration of abdominal pain,the recovery time of blood amylase and hospitalization in ERCP group were significantly shorter compared to the non-ERCP group ( 10.2 ± 1.7 ) d v.s.( 13.2 ±2.4)d,(3.3 ±1.0)dv.s.(5.5 ±1.2)d,(15 ±1.6)dv.s.(20±3.0)d] (P＜0.05),and complication rate of the ERCP group was lower,too (5％ v.s.22％,P ＜ 0.05).Conclusion Early ERCP is safe and highly effective for the elderly patients with acute severe biliary pancreatitis.