经内镜治疗急性胆源性胰腺炎80例临床报告  

Clinical report of endoscopic therapy of biliary obstructive acute pancreatitis 80 cases

作　　者：施伟斌[1] 王雪峰[1] 张文杰[1] 董平[1] 

机构地区：[1]上海第二医科大学附属新华医院普外科,上海200233

出　　处：《中国内镜杂志》2006年第7期692-694,共3页China Journal of Endoscopy

摘　　要：目的观察内镜治疗急性胆源性胰腺炎的疗效及其并发症。方法80例急性胆源性胰腺炎患者在抗炎抑酶等综合治疗的基础上,行内镜(1￣3d内)逆行胰胆管造影(ERCP)及经内镜十二指肠乳头括约肌切开(EST)或鼻胆管引流(ENBD)等治疗。结果经内镜治疗后72例(90%)急性轻症胆源性胰腺炎(MABP)患者2～5d体温恢复正常;急性重症胆源性胰腺炎(SABP)患者3～8d腹部体征好转,血常规、淀粉酶及血生化1、2周内基本恢复,平均住院18.7d。8例形成急性坏死性胰腺炎转外科手术,平均住院65.9d,3例死亡。内镜治疗过程中5例出现十二指肠乳头括约肌切口出血,经局部喷洒凝血酶止血外,未再出现其他并发症。结论急性胆源性胰腺炎早期ERCP及内镜治疗安全有效。[Objective] To observe the success rate, theraputic effects and complications of endoscopic therapy in patients of Biliary obstructive Acute Pancreatitis（BOAP）. [Methods] Based on comprehensive treatment including anti-inflammatory and anti-enzyme therapy, 80 patients of BOAP who underwent ERCP, EST OR ENBD within 3 days were analyzed retrospectively. [Results] Among 80 patients who underwent endoscopic therapy, 90%（72/80） had favorable results. After therapy, patients who had fever came back to normal body temperature in 2-5 days, patients who had peritonitis had better physical sign in 3-8 days. All 72 patients turned to normal range of blood test results, biochemical test results and blood amylase level in 1-2 weeks and were discharged in 5-30 days. 10%（8/80） of 80 patients who had acute necrotic pancreatitis were transferred to surgical therapy. During endoscopic therapy, 5 patients presented incision site hemorrhage of sphincter of papilla of duodenum, no other complications were observed. [Conclusion] Early endoscopic therapy is safe and effective in BOAP patients,the therapy should be performed as early as possible to reduce the risk of severe acute pancreatitis.

关 键 词：胆源性胰腺炎 内镜 逆行胰胆管造影 经内镜十二指肠乳头括约肌切开 鼻胆管引流 

分 类 号：R576[医药卫生—消化系统]