超声内镜在可疑急性梗阻性胆源性胰腺炎诊治中的运用价值  

Endoscopic ultrasonography applied in the management of suspected obstructive jaundice in acute biliary pancreatitis

作　　者：邓尚新[1] 康生朝[1] 汪泳[1] 耿闻男[1] 刘鑫[1] 秦仕钊 张方信[1] 

机构地区：[1]兰州军区兰州总医院消化内科,甘肃兰州730050

出　　处：《中国内镜杂志》2016年第9期75-79,共5页China Journal of Endoscopy

摘　　要：目的探讨超声内镜(EUS)在可疑急性梗阻性胆源性胰腺炎病因诊断中的价值及对患者临床治疗结局的影响。方法回顾分析96例可疑急性梗阻性胆源性胰腺炎患者,分成早期EUS筛查组(EES)和推迟EUS筛查组(DES),比较两组患者临床治疗结局和检验指标的差异。结果 EUS对结石诊断的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为96.43%、82.50%、90.63%、88.52%及94.29%。早期(72 h内)EUS检查明确病因后予以内镜干预治疗能使患者白细胞计数(WBC)、中性粒细胞百分比(N%)、总胆红素(TBIL)和血淀粉酶(AMS)更快下降(P<0.05);EES组比DES组1周腹痛缓解率更高(87.50%vs66.67%,P=0.027)、出院更快[(12.70±2.10)d vs(14.10±3.00)d,P=0.006];推迟EUS检查患者WBC、TBIL早期明显增高,器官衰竭发生率和胰腺感染脓肿率有增高趋势。结论可疑急性梗阻性胆源性胰腺炎患者应尽早施行内镜治疗。EUS检查结果是内镜治疗前的决策依据,能改善患者临床指标和预后,避免不必要的内镜治疗风险。Objective To explore the application value of endoscopic ultrasonography （EUS） in the diagnosis of suspected obstructive jaundice in acute biliary pancreatitis and its effect on treatment outcomes. Methods Clinical data were retrospectively collected in 96 patients with acute biliary pancreatitis （ABP） who were suspected obstructive jaundice. Patients were divided into early EUS scanning group （EES） and delay EUS scanning group （DES）. Clinical treatment results and test results were compared between the two groups. Results The diagnosis sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EUS were 96.43 %, 82.5 %, 90.63 %, 88.52 % and 96.29 %. Early EUS scan with 72 h could identify the etiology of ABP and subsequent treatment based on the EUS can easily decrease the white blood cell count, percentage of neutrophils, total bilirubin and serum amylase （P 〈 0.05）. The pain relief rate in EEl group after 1 week treatment was significantly higher than that in the DES group （87.50 % vs 66.67 %, P = 0.027） and average length of hospitalization was shorter [（12.70 ±2.10） d vs （14.10 ±3.00） d, P = 0.006]. Delay EUS scan were likely to have higher white blood cell count and total bilirubin, meanwhile seemed to increase the organ failure rate and necrotic infection of the pancreas. Conclusion ABP with suspected obstructive jaundice should be considered to have endoscopy intervention. Results of EUS are the basis for treatment decision, which can avoid the unnecessary endoscopy treatment.

关 键 词：急性胆源性胰腺炎 内镜治疗 可疑梗阻 

分 类 号：R576[医药卫生—消化系统]