EST+胆胰管引流治疗急性胆源性胰腺炎  

CLICINICAL IMPLICATIONS OF TREATMENT OF THE ACUTE GALLSTONE PANCREATITIS BY USING THE EST TECHNOLOGY

作　　者：周鸣清[1] 陈欣然[1] 

机构地区：[1]上海市闸北区中心医院,上海200070

出　　处：《肝胆外科杂志》2007年第4期269-272,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨内镜下乳头奥迪氏扩约肌切开(endoscopic sphincterotomy,EST)+胆胰管引流技术在急性胆源性胰腺炎(acute biliary pancreatitis,ABP)诊治中的应用价值。方法将入选的315例ABP患者随机分为EST治疗组(n=132)和非EST对照组(n=183),并根据APACHEⅡ评分,将每组再进一步分为重症组和轻症组。两组患者均给予中西医结合治疗。EST治疗组在入院后24 h内行ERCP(endoscopic retrograde cholangiopancreatography)+EST,如发现胆管或胆胰共同通道有结石,则行网篮气囊取石或碎石器碎石取石,如结石多、结石直径大,结石难以一次取尽则急诊不强行取石术。如ERCP证实胰管狭窄或胰管有结石,则行胰管支架植入或鼻胰管引流。所有患者EST术后均行鼻胆管引流术(endoscopic naso-billiarydrainage ENBD)。结果对重症ABP,EST治疗组的并发症发生率、转开腹手术率、住院天数及住院费用均明显低于非EST对照组(X12=7.12,X22=5.64,t1=2.57,t2=2.28,P<0.05);而两组轻症之间无显著差异。结论早期应用EST技术治疗ABP是可行的、有效的和安全的。Objective Explore the clinical value of the treatment of the acute biliary pancreatitis （ABP） by using the endoscopic sphincterotomy （EST）. Methods The 315 selected patients with acute biliary pancreatitis, were randomly divided into EST treatment group （n = 132） and non - EST control group （n = 183）. Each group was further broken down into severe group and minor group according to the APACHE Ⅱ values. Patients of both the EST and the control groups were treated with the combination of the Chinese traditional and Western medicine. Endoscopic retrograde cholangiopancreatography （ERCP） plus EST was performed for the patients in the EST group after 24h of hospitalization. Lithotomy was carried out by using the basket air sac or lithotriptor, if stones had been found in the common bile duct or the billiary and pancreatic common path. Endoscopic naso-billiary drainage （ENBD） was done after EST in case of multi stones, or stones with large diameters, or remaining stones after lithotomy. Results The complication incidence, rate of laparotomy, time of hospitalization and hospitalization expenses for the cases in the severe ABP and EST groups were explicitly lower than those for the patients in the non-EST control （X1^2 = 7. 12, X2^2 = 5.64, t1 = 2. 57, t2 = 2. 28, P 〈 0. 05）. And there had no significant importance for the values between their two minor groups. Conclusion Early treatment of cases with severe ABP by EST is applicable, effective and safe.

关 键 词：胆源性胰腺炎 治疗 ERCP EST 

分 类 号：R657.11[医药卫生—外科学]