早期内镜治疗急性胆源性胰腺炎的随机对照临床试验  

Randomized controlled trials on early Endoscopic intervention in acute biliary pancreatitis

作　　者：胡红强[1] 肖青川[1] 罗伟[1] 秦红军[1] 李俊[1] 杜淑珍[1] 王永红[1] 

机构地区：[1]武警四川总队医院肝胆外科,四川乐山614000

出　　处：《中国现代医学杂志》2009年第24期3803-3806,共4页China Journal of Modern Medicine

摘　　要：目的探索早期内镜治疗急性胆源性胰腺炎(ABP)的临床疗效。方法以我院2004年5月至2007年12月共80例ABP住院患者为研究对象,随机分为两组。试验组40例,在症状首发后72h内行内镜治疗;对照组40例,除不予内镜治疗外,其他同试验组。观察两组病死率、并发症发生率、住院时间、住院费用等指标。结果完成试验79例(试验组40例,对照组39例)。用末次观察结果转接(CFLO)和意向性治疗(ITT)分析纳入病例。试验组与对照组比较,并发症发生率降低(P=0.025),住院时间缩短(P=0.00),入院后腹痛缓解时间(P=0.00)、体温恢复正常时间(P=0.03)、腹部体征消失时间(P=0.01)均缩短。病死率(P=0.20),血清淀粉酶恢复正常时间(P=0.07),住院费用(P=0.79)两组比较无显著性差异。结论早期内镜治疗ABP能减少并发症,缩短住院时间,可在有条件的单位作为首选治疗手段。【Objective】 To assess the therapeutic effect of early endoscopic intervention in acute biliary pancreatitis （ABP）.【Methods】 80 consecutive patients with ABP in our hospital from May 2004 to December 2007 were randomly allocated into a test group （40 patients）,in which＇Early endoscopic intervention＇was applied to ABP patients in 72 hours after attack;And a control group （40 patients）,in which all treatments were applied as seem as the test group except ＇early endoscopic intervention＇.The baseline of the two groups,the time of bellyache relief,the mortality,the incidence of complications and hospital stay were observed,as well as the hospital expense.【Results】 Participant underwent intention-to-trea（tITT）analysis.The incidence of complications and hospital stay were significantly lower in test group than those in control group （P =0.00,P =0.03 respectively）.Significant differences were found between the test and control groups regarding the time of bellyache relief （P =0.00）,the time of temperature normalizing （P =0.03）.However,there was no statistical significance in hospital cost （P =0.79）,the mortality （P=0.20）and the time of serum amylase normalizing （P =0.07） between the two groups.【Conclusion】 Early endoscopic intervention in ABP which may be a routine method can increase the curative effect,decrease complications and reduce the time of hospital stay.

关 键 词：急性胰腺炎 内镜逆行胰胆管造影 内窥镜括约肌切开术 内窥镜下鼻胆管引流 随机对照试验 

分 类 号：R575.6[医药卫生—消化系统]