ERCP治疗急性胆源性胰腺炎疗效的临床研究  

The researth of clinical effect of ERCP in treatment of acute biliary pancreatitis

作　　者：朱振中 汤亲青[1] 张剑林[1] 方茂勇[1] 

机构地区：[1]安徽医科大学第一附属医院急诊外科,合肥230022

出　　处：《肝胆外科杂志》2016年第1期29-31,共3页Journal of Hepatobiliary Surgery

基　　金：安徽省自然科学基金(1408085QH172)

摘　　要：目的回顾性分析ERCP术与传统开腹下胆总管切开取石术治疗胆源性胰腺炎的临床疗效。方法调取2012年1月至2015年10月安徽医科大学第一附属医院急诊外科收治的胆管结石伴急性胰腺炎患者病例86例,按照治疗方式不同分为ERCP组(56例应用ERCP+EST+ENBD)和CBDE组(传统开腹下胆总管切开取石+术中胆道镜探查+T管引流术30例)。观察两组术前及术后白细胞(WBC)、血淀粉酶(AMYL)、总胆红素(TBIL)、谷丙转氨酶(ALT)、CRP水平的变化及腹部症状缓解时间、肠道恢复时间、住院总时间、住院总费用、结石清除率及术后并发症。结果两组术前一般资料、各实验室指标及结石大小差异均无统计学意义(P>0.05);ERCP组住院总时间、住院总费用、术后腹痛缓解及胃肠道通气时间均较CBDE组降低,差异有统计学意义(P<0.05);且ERCP组术后第3天及第7天同一时间点WBC、AMYL、TBIL、ALT、CRP均较CBDE组降低,有统计学差异(P<0.05)。结论 ERCP在胆总管结石伴急性胰腺炎的治疗中安全有效,术后恢复良好,可有效减少住院时间,降低住院总费用,减轻患者身体及经济负担。Objective To retrospectively analyzed the clinical effect of ERCP and common bile duct exploration combined with endobiliary drainage in the treatment of acute biliary panereatitis. Methods The analysis was performed on the clinical date of 86 patients with acute pancreatitis with common bile duet stones admitted to the first affiliated hospital of Anhui medical university emergency surgical department from January 2012 to October 2015. Divided the patients into 2 groups according to the different treatments. Among them , 56 patients received ERCP ＋ EST ＋ ENBD （ ERCP group） and 30 patients underwent common bile duct exploration combined with endobiliary drainage （CBDE group）. Changes in white blood cell （WBC） count, total bilirubin （TBil） , alanine aminotransferase （ALT） , and C-reactive protein （CRP） after operation, The blood amylase （AMYL）, abdominal symptoms, intestinal recovery time, total time in hospital, the hospital total cost, stone clearance rate and postoperative complications were analyzed. Results There were no significant differences in preoperative general information, the laboratory indexes and the size of the stone between the two groups （ all P 〉0. 05 ）. Total time in hospital, the hospital total cost, postoperative abdominal pain relief and gastrointestinal ventilation time in ERCP group was lower than the matched group, the difference was statistically significant （ P 〈 0. 05 ） ; And the result was same at WBC count and AMYL, TBIL, ALT, CRP level on the day 3rd and 7th days after surgical （P 〈 0. 05）. Conclusion ERCP is safe and feasible for common bile duct stones with acute pancreatitis , it has a good postoperative recovery , reduce the length of hospital stay ,the cost of hospitalization and the patient＇s economic burden.

关 键 词：ERCP 胆总管结石 急性胆源性胰腺炎 

分 类 号：R657.4[医药卫生—外科学]