急性胆源性胰腺炎的个体化治疗分析

目的 探讨急性胆源性胰腺炎（ABP）临床个体化治疗方法及效果。方法 回顾性分析34 例ABP患者的临床资料。其中原发病为胆囊结石18例,胆总管结石7例,胆囊结石合并胆总管结石 5 例,未见胆囊及胆管结石但有胆总管扩张表现 4例;轻型急性胰腺炎11 例,重症急性胰腺炎23例。34例均在采用保守治疗的同时实施早期微创治疗,其中经皮肝穿刺胆管引流术（PTCD）15例;胆囊穿刺引流术10例;经内镜逆行胰胆管造影术（ERCP）4例;经皮穿刺胰周引流术＋胆囊穿刺1例,经皮穿刺胰周引流术＋PTCD 4例,其中3例（8.82%）经上述治疗后无缓解施行急诊手术（胆囊切除＋胆总管切开取石＋T管引流术＋胰腺坏死组织清除术＋胰周引流术1例,以及加腹腔减压术2例）。结果 3例急诊手术患者中,2例治愈出院后无ABP再次发作,1例死亡;26例（76.47%）择期手术（胆囊切除术22例、胆囊切除＋胆总管切开＋T管引流术 4例）,随访期间,无ABP再次发作;4例（ 11.76%）患者暂未行手术治疗,随访期间4例中均无ABP再次发作;1例患者微创介入治疗（PTCD）后,住院期间死亡未行手术治疗。全组并发心功能损害15 例（44.12%）,肾功能损害 11 例（32.35%）,肝损害 12例（35.29%）,急性肺部感染9例（26.47%）。治愈32例（94.12%）,死亡2例（5.88%）。结论 对于ABP的治疗应按不同病因和病期采取个体化治疗方案,早期ERCP、超声引导下经皮经肝胆管或胆囊穿刺引流或胰周引流能显著提高疗效。

Analysis of the individualized therapeutic regimen of acute biliary pancreatitis

Objective To investigate the clinical treatment and effect of the acute biliary pancreatitis （ABP） clinical treatment and effect. Methods Clinical data of 34 cases of ABP were retrospectively analyzed. Among them, 18 cases of the incidence of gallstone original, 7 cases of common bile duct stones, gallstones and common bile duct stones in 5 cases, no gallbladder and bile duct stones but 4 cases of common bile duct dilation performance,mild acute pancreatitis in 11 cases, 23 cases of severe acute pancreatitis. Thirty-four cases were treated conservatively, while the implementation of an early invasive treatment, percutaneous transhepatic cholangial drainage（PTCD） 15 cases, 10 cases of gallbladder puncture anddrainage, 4 cases of endoscopic retrograde cholangiopancreatography（ERCP）, percutaneous drainage of pancreatic＋gallbladder puncture 1 case,percutaneous peripancreatic drainage＋PTCD 4 case. Three cases （8.82%） after the implementation of the above treatment without remission emergency surgery（gallbladder removal＋common bile duct exploration＋T-tube drainage of pancreatic necrotic tissue dissection 1 case, gallbladder removal＋common bile duct exploration＋T-tube drainage＋pancreatic debridement of necrotic tissue and drainage of peripancreatic abdominal decompression surgery＋2 cases）. Results Three cases of emergency surgery patients, 2 patients were cured without recurrence ABP, 1 case died, 26 cases （76.47%） underwent elective surgery （cholecystectomy in 22 cases, the common bile duct cut ＋gallbladder removal ＋ T tube drainage 4 cases）,during follow-up, no ABP attack again. Four cases （11.76%） patients without underwent surgery, during follow-up, 4 cases had no ABP attack again. One patient after minimally invasive treatment （PTCD） during hospitalization death without surgery ,Full set of concurrent cardiac dysfunction in 15 cases （44.12%）, renal dysfunction in 11 patients （32.35%）, liver damage in 12 cases （35.29%）, acute lung infection in 9 cases （26.47%）. 32 cases was cured （94.12%）, 2 cases （5.88%） died. Conclusions The treatment of acute gallstone pancreatitis should be individualized according to the different causes and disease stage, early ERCP, Ultrasound-guided percutaneous drainage of the gallbladder or bile duct or pancreatic drainage can significantly improve the results.