早期重症急性胆源性胰腺炎内镜逆行胆胰管造影的治疗价值  

Application value of endoscopic retrograde cholangiopancreatography in the early stage of severe acute biliary pancreatitis

作　　者：邓尚新[1] 康生朝[1] 王静舞[1] 耿闻男[1] 刘鑫[1] 张方信[1] 

机构地区：[1]兰州军区兰州总医院消化内科,700533

出　　处：《武警医学》2016年第7期706-709,713,共5页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的探讨在早期重症急性胆源性胰腺炎(severe acute biliary pancreatitis,SABP)内镜逆行胆胰管造影术(endoscopic retrograde cholangiopancreatography,ERCP)的治疗价值。方法 2011-07至2015-07我科收治的SABP患者经知情同意后分为早期内镜治疗组(EEI)和早期非手术治疗组(ECM),每组43例;比较两组治疗前后白细胞计数(WBC)、中性粒细胞百分比值(N%),总胆红素(TBIL)、白细胞介素6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)变化,腹痛缓解时间、住院时长、器官衰竭发生率的区别。结果 EEI组与ECM组相比,平均住院天数[(24.8±4.8)d vs(28.3±6.1)d]明显减少,器官衰竭总发生率(30.2%vs 53.5%)明显降低,1周内腹痛缓解率(83.7%vs 60.4%)更高(P<0.05)。ECM组胰腺感染坏死发生率较EEI组有增高趋势(P=0.062)。EEI组患者ERCP治疗后WBC、N%、IL-6、TBIL较入院时明显降低(P<0.05),1周后N%、PCT、IL-6、CRP、TBIL进一步下降(P<0.05)。ECM组治疗72 h未能使WBC、N%、PCT、IL-6、CRP、TBIL下降,予以ERCP治疗后WBC、N%、IL-6、TBIL明显降低(P<0.05);部分未行介入治疗的ECM患者治疗1周后N%、PCT、IL-6、CRP无明显降低。ERCP治疗患者未见相关并发症。结论在SABP综合治疗中,早期予以ERCP治疗安全、有效、可行,可改善临床症状、指标,缩短病程,使患者早日康复。Objective To assess the efficacy of early endoscopic retrograde cholangiopancreatography（ ERCP） in the management of severe acute biliary pancreatitis（ SABP） compared with conservative treatment. Methods SABP patients were divided into early endoscopic intervention group（ EEI） and early conservative management group（ ECM） after informed consent from July 2011 to July2015 in this department. The following indexes,such as the white blood cell count（ WBC）,neutrophil percentage（ N%）,total bilirubin（ TBIL）,interleukin 6（ IL-6）,C-reactive protein（ CRP）,calcitonin（ PCT）,abdominal pain relief time,duration of hospitalization and incidence of organ failure were compared between the two groups. Results The average duration of hospitalization [（ 24. 8 ± 4. 8） d vs（ 28. 3 ±6. 1） d]and the incidence of organ failure（ 30. 2% vs 53. 5%） in the EEI group were significantly lower than that in the ECM group,and the pain relief rate（ 83. 7% vs 60. 4%） was higher in the EEI group（ P〈0. 05）. The incidence of necrotic infection of the pancreas in ECM group was likely higher than that in EEI group（ P = 0. 062）. Indexes of WBC,N%,IL-6 and TBIL significantly decreased after ERCP intervention in the EEI group,and N%,PCT,IL-6,CRP and TBIL were lower after 1 week of treatment than that of post-ERCP. ECM group failed to decrease the indexes of WBC,N%,PCT,IL-6,CRP and TBIL after conservative treatment for 72 h.Patients undergoing ERCP in ECM group had significantly lower WBC,N%,IL-6 and TBIL than the indexes of 72 h after admission（ P〈0. 05）. Patients treated after 1 week without ERCP had no changes in N% PCT,IL-6 and CRP. ERCP related complications were not seen in both groups. Conclusions ERCP intervention in the early stage of SABP is safe,effective and feasible,and it can improve clinical symptoms and indexes,shorten the course of disease,and promote the recovery of SABP patients.

关 键 词：重症急性胆源性胰腺炎 内镜逆行胆胰管造影术 治疗效果 

分 类 号：R576[医药卫生—消化系统]