急诊ERCP在急性胆源性胰腺炎治疗中的应用  

Application of emergency therapeutic endoscopic retrograde cholangio-pancreatography(ERCP) in patients with acute biliary pancreatitis

作　　者：刘玉杰[1] 江堤[1] 苏剑东[1] 黄友明[1] 李学谦[1] 孙贤久[1] 麦海珠[1] 杨巧玲[1] 廖秀敏[1] 龚飞跃[2] 

机构地区：[1]广东省东莞东华医院消化内科,广东东莞523110 [2]珠海市人民医院消化内科,广东珠海519000

出　　处：《肝胆胰外科杂志》2012年第4期278-280,285,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨急诊ERCP在急性胆源性胰腺炎(ABP)急性反应期中的作用与地位。方法回顾分析92例ABP患者,根据是否早期接受急诊ERCP分为ERCP组(ERCP组,52例)和非ERCP组(N-ERCP组,40例)。观察ERCP组中胆总管微小结石或胆泥发生率;比较两组重症胰腺炎发生率、腹痛缓解时间、血清淀粉酶及肝功能变化。结果 ERCP组中49例急诊ERCP治疗成功,成功率达94.2%。ERCP组中,胆总管微小结石及胆泥共6例,占胰腺炎病因11.5%(6/52);ERCP组重症胰腺炎发生率[5.8%(3/52)]明显低于N-ERCP组[20%(8/40)](P<0.05)。ERCP组腹痛缓解时间(3.5±1.1 d vs 5.0±1.5 d)、血清淀粉酶下降速度(50±135 U/L vs 201±120 U/L)、肝功能(TBIL:125±114μmol/L vs 250±140μmol/L;ALT:210±183 U/L vs 452±215 U/L;GGT:241±198 U/L vs 450±285 U/L)改善情况均优于N-ERCP组(P<0.05)。结论急诊治疗性ERCP可显著缓解临床症状和降低重症胰腺炎发生率。Objective To explore the function and role of emergency therapeutic endoscopic retrograde cholangio-pancreatography （ERCP） on patients with acute biliary pancreatitis. Methods Ninety-two patients with acute biliary pancreatitis were studied and analyzed retrospectively. The patients were divided into two groups; the ERCP group of 52 patients who underwent emergency therapeutic ERCP, and the N-ERCP group of 40 patients who underwent traditional treatment without emergency ERCP. The way is to observe and record the occurrence rate of the common bile duct stones, especially microlithiasis or biliary sludge, in the ERCP group. More, the occurrence of severe pancreatitis, the relief time of abdomianl pain and the serum biochemical changes of these patients were also analyzed and compared between the two groups. Results In the ERCP group, 49 （94.2%） patients with acute biliary pancreatitis successfully received ERCP combined with endoscopic sphincterotomy and swept the common bile duct by balloon catheter. Six patients （11.5%） in the ERCP group were found with microlithiasis or biliary sludge in common bile duct. The rate of occurrence of severe pancreatitis in the ERCP group was much lower than that in the N-ERCP group, which respectively was 5.8%（3/52） and 20% （ 8/40 ）. In addition, compared with the N-ERCP group, the relief time of abdomianl pain was shorter in the ERCP group. Consequently, after 3 days＇ operation in the ERCP group, the serum amylase （AMY）, total bilirubin （TBIL）, glntamyl transferase （GGT） and alanine aminotransferase （ALT） of 49 patients decreased significantly. Conclusion Emergency therapeutic ERCP can markedly reduce the risk of developing to severe acute pancreatitis.

关 键 词：急性胆源性胰腺炎 急诊ERCP 微小结石 

分 类 号：R657.51[医药卫生—外科学]