早期胰管支架置入治疗急性胰腺炎的临床疗效  

Clinical efficacy of early pancreatic duct stenting in the treatment of acute pancreatitis

作　　者：姚维杰 王佐正[1] 杨亚飞 兰柱 宋建军[1] 金栋[3] 侍明海[4] 黎明[1] 卜稳平 王根旺[1] Yao Weijie;Wang Zuozheng;Yang Yafei;Lan Zhu;Song Jianjun;Jin Dong;Shi Minghai;Li Ming;Bu Wenping;Wang Genwang(Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University,Yinchuan 710004,China;Ningxia Medical University,Yinchuan 710004,China;Hepatobiliary Surgery Group,Cardio-vascular and Cerebrovascular Disease Hospital of Ningxia Medical University,Yinchuan 750002,China;Department of Radiology,General Hospital of Ningxia Medical University,Yinchuan 710004,China)

机构地区：[1]宁夏医科大学总医院肝胆外科,银川710004 [2]宁夏医科大学,银川710004 [3]宁夏医科大学心脑血管病医院肝胆外科组,银川750002 [4]宁夏医科大学总医院放射科,银川710004

出　　处：《中华消化外科杂志》2021年第12期1318-1323,共6页Chinese Journal of Digestive Surgery

基　　金：宁夏自治区重点研发计划项目重点项目(2020BEG02002,2021BEG03042);宁夏医科大学总医院开放课题(2020);宁夏自治区科技支撑项目(2015KJHM40)

摘　　要：目的探讨早期胰管支架置入治疗急性胰腺炎的临床疗效。方法采用回顾性描述性研究方法。收集2011年10月至2017年12月宁夏医科大学总医院收治的201例急性胰腺炎病人的临床资料;男106例, 女95例;中位年龄为62岁, 年龄范围为18~90岁。201例病人中, 178例为中度重症急性胰腺炎, 23例为重度重症急性胰腺炎。病人入院后48 h内行胰管支架置入治疗急性胰腺炎。观察指标:(1)治疗情况。(2)随访情况。采用门诊及电话方式进行随访, 了解病人术后急性胰腺炎复发情况。随访时间截至2019年6月。正态分布的计量资料以x±s表示, 组间比较采用独立样本t检验, 前后比较采用配对样本t检验;偏态分布的计量资料以M(P25, P75)或M(范围)表示, 组间比较采用Mann-WhitneyU检验, 前后比较采用Wilcoxon符号秩和检验。计数资料以绝对数或百分比表示, 组间比较采用χ2检验。结果 (1)治疗情况:201例病人均成功完成早期胰管支架置入, 63例术中可见白色絮状物堵塞胰管。201例病人入院到手术等待时间为10 h(4 h, 22 h), 手术时间为(35±15)min, 首次经口进食时间为3 d(2 d, 5 d), 总住院时间为6 d(5 d, 10 d), 住院费用为3.8万元(3.0万元, 4.9万元)。201例病人中, 22例转重症监护室治疗(其中1例重度重症病人住院期间死亡, 1例中度重症和7例重度重症病人自动出院);25例发生局部并发症, 其中17例为胰腺感染性坏死, 7例为胰腺包裹性坏死, 1例为脾梗死, 经外科干预或保守治疗后均治愈。进一步分析, 178例中度重症病人和23例重度重症病人转重症监护室治疗、外科干预治疗、首次经口进食时间、总住院时间、自动出院分别为6例、11例、3 d(2 d, 5 d)、6 d(5 d, 10 d)、1例和16例、5例、7 d(4 d, 9 d)、9 d(7 d, 17 d)、7例, 两者上述指标比较, 差异均有统计学意义(χ2=91.561, 6.730, Z=6.485, 5.463, χ2=47.561, P<0.05)。201例病人入院前和入院48 hObjective To investigate the clinical ffcacy of early pancreatic duct stenting n the treatment of acute pancreatitis.Methods The retrospective and descriptive study was conducted.The clinical data of 201 patients with acute pancreatitis who were admitted to General Hospital of Ningxia Medical University from October 2011 to December 2017 were collected.There were 106 males and 95 females,aged from 18 to 90 years,with a median age of 62 years.Of 201 patients,there were 178 cases with moderate severe acute pancreatitis and 23 cases with serious severe acute pancreatitis.Patients were treated with pancreatic duct stenting within 48 hours after admission.Observation indicators:(1])treatment;(2)follow-up.Follow-up was conducted using outpatient examination and telephone interview to detect recurrence of acute pancreatitis after surgery up to June 2019.Measurement data with normal distribution were represented by MeantSD,and the independent sample t test was used for comparison between groups,and the matched samples t test was used for comparison between before and after.Measurement data with skewed distribution were represented by M(P25,P75]or M(range),and the Mann-Whitney U test was used for comparison between groups,and the Wilcoxon signed rank sum test was used for comparison between before and after.Count data were expressed as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test.Results(1)Treatment:201 patients received pancreatic duct stenting successfully,63 of which were detected pancreatic obstruction with white-floc.The interval time from admission to surgery,operation time,time for initial oral intake,duration of hospital stay and hospital expenses of 201 patients were 10 hours(4 hours,22 hours),(35+15)minutes,3 days(2 days,5 days),6 days(5 days,10 days)and 3.8x 10^(4)yuan(3.0x10*yuan,4.9x10^(4)yuan).Of 201 patients,22 patients were transferred to intensive care unit,including 1 case with serious severe underwent inhospital death and 1 case with moderate sever

关 键 词：胰腺炎 急性 胰管支架 内镜 内镜逆行胰胆管造影 

分 类 号：R657.51[医药卫生—外科学]