内镜下十二指肠乳头切开术治疗急性胆源性胰腺炎的临床研究

目的探讨逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)和十二指肠乳头切开术(endoscopic sphincterotomy,EST)联合治疗急性胆源性胰腺炎(acute biliary pancrea-titis,ABP)的疗效以及安全性。方法选取2009年1月～2011年9月期间在我院急诊科就诊的ABP 58例,随机分为A组和B组,每组各29例。A组采取在常规治疗的基础上,同时加行ERCP+EST联合治疗;而B组患者仅给予一般常规治疗,当出现胆道梗阻、穿孔或胰腺脓肿及胰腺假性囊肿时则积极开腹手术。记录腹痛缓解时间、血淀粉酶恢复正常时间、住院天数、并发症发生率和死亡率等。结果 A组与B组腹痛缓解时间分别为(5.21±2.08)d vs.(13.56±6.28)d,血淀粉酶恢复时间为(7.66±4.15)d vs.(12.32±5.81)d,住院时间为(18.42±5.73)d vs.(26.12±12.15)d,住院费用为(1.86±1.15)万元vs.(5.46±2.37)万元,并发症发生率为6.90%(2/29)vs.34.48%(10/29),死亡率为6.90%(2/29)vs.27.59%(8/29)。两组比较差异显著(P<0.05)。结论早期采用ERCP+EST联合治疗ABP是安全有效的。

Clinical Observation of Therapeutic Effect of ERCP plus EST in the Treatment of Acute Biliary Pancreatitis

Objective To evaluate the efficacy and safety of the therapeutic alliance of endoscopic retrograde cholangiopancreatography(ERCP) plus endoscopic sphincterotomy(EST) in the treatment of acute biliary pancreatitis(ABP).Methods 58 patients diagnosed as ABP were randomly assigned to receive ERCP plus EST(n=29,study group) or the regimen of general conventional treatment(n=29,control group).In the study group,the patients received ERCP plus EST on the base of general conventional treatment.In the control group,the patients received general conventional treatment unless the operations were necessary for the complications such as biliary tract obstruction,perforation,pancreatic abscess or pseudocyst.Results It showed statistically significant differences(P<0.05) in the study group and the control group,of the duration time of abdominal pain relief(5.21±2.08) d vs.(13.56±6.28)d,the duration of hemodiastase recovery(7.66±4.15)d vs.(12.32±5.81)d,hospital stay(18.42±5.73)d vs.(26.12±12.15) d,cost of hospitalization(1.86±1.15)×104 RMB vs.(5.46±2.37)×104 RMB,complication rate 6.90%(2/29) vs.34.48%(10/29) and the mortality rate 6.90%(2/29) vs.27.59%(8/29).Conclusion It is safe and effective of the combined treatment of ERCP plus EST for the ABP patients in the early stage.