早期内镜下逆行胆胰管造影治疗急性胆源性胰腺炎的安全性和有效性评价  

Safety and efficacy of early endoscopic retrograde cholangiopancreatography in treatment of acute biliary pancreatitis

作　　者：崔建华[1] 徐康[1] 赵昌杰[1] 陈林[1] 

机构地区：[1]江苏省东台市人民医院消化内科,江苏省东台市224200

出　　处：《世界华人消化杂志》2013年第32期3571-3575,共5页World Chinese Journal of Digestology

摘　　要：目的:探讨和评价早期行内镜下逆胆胰管造影治疗急性胆源性胰腺炎(acute biliary pancreatitis,ABP)的安全性和有效性.方法:选择2008-01/2012-12于我院就诊的105例ABP患者,随机分为实验组53例和对照组52例.对照组采用常规基础治疗,实验组早期行治疗性内镜逆行胰胆管造影(endoscopic retrogradecholangio-pancreatography,ERCP).统计两组患者入院时和入院后的APACHEⅡ评分和Ranson评分.观察患者入院时和入院后的血清炎症因子水平等指标.统计两组术后并发症发生率和死亡率.结果:入院后实验组APACHEⅡ评分是6.4分±2.1分,Ranson评分是2.1分±0.9分,对照组分别是9.8分±3.8分和2.6分±1.1分,实验组入院后的APACHEⅡ评分和Ranson评分低于对照组,差异有统计学意义(P<0.05).实验组治疗后的炎症因子均低于对照组,差异有统计学意义(TNF-:55.6 g/L±16.8 g/Lvs 230.4g/L±33.1 g/L;CRP:7.6 mg/dL±2.5 mg/dL vs 11.1 mg/dL±2.7 mg/dL,均P<0.05).实验组血清淀粉酶恢复正常时间(d)、腹痛缓解时间(d)、肝功能恢复时间(d)和住院时间(d)均低于对照组,差异有统计学意义(8.2 d±2.2 d vs 11.8 d±4.2 d,7.2 d±2.4 d vs 11.2 d±3.1 d,12.6 d±4.4 d vs 23.4 d±6.1 d,16.6 d±4.8 d vs24.5 d±6.7 d,均P<0.05).实验组术后并发症发生率低于对照组(9.43%vs 25.00%),差异有统计学意义(P<0.05).结论:早期行内镜下逆胆胰管造影治疗ABP安全有效.AIM： To evaluate the safety and efficacy of early endoscopic retrograde cholangiopancreatogra- phy （ERCP） in treatment of acute biliary pancre- atitis. METHODS： One hundred and five patients with acute biliary pancreatitis treated at our hospital from January 2008 to December 2012 were ran- domly divided into either a control group （n = 52） or a test group （n = 53）. The control group underwent conventional basic treatment, and the test group underwent early ERCP. APA- CHEII score and Ranson score were recorded. Inflammatory factors were detected. Postopera- tive morbidity and mortality were compared. RESULTS： The APACHEII score and Ransonscore after admission were significantly lower in the test group than in the control group （6.4 ± 2.1 vs 9.8 ± 3.8, 2.1 ±0.9 vs 2.6 ± 1.1, both P 〈 0.05）. The levels of inflammatory factors after treatment were also significantly lower in the test group than in the control group （TNF-α： 55.6 μg/L ± 16.8 μg/L vs 230.4 μg/L ± 33.1 μg/L; CRP： 7.6 mg/dL ± 2.5 mg/dL vs 11.1 mg/dL ± 2.7 mg/dL, both P 〈 0.05）. The times required for serum amylase to return to normal, relief of abdominal pain, recovery of liver function and hospital stay were significantly lower in the test group than in the control group （8.2 d ± 2.2 d vs 11.8 d ± 4.2 d, 7.2 d ± 2.4 d vs 11.2 d ± 3.1 d, 12.6 d ± 4.4 d vs 23.4 d ± 6.1 d, 16.6 d ± 4.8 d vs 24.5 d ±6.7 d, all P 〈 0.05）. The rate of postoperative complications was significantly lower in the test group than in the control group （9.43% vs 25.00%, P 〈 0.05）. CONCLUSION： Early ERCP is safe and effective in the treatment of acute biliary pancreatitis.

关 键 词：早期行内镜下逆胆胰管造影治疗ABP安 全有效 

分 类 号：R576[医药卫生—消化系统]