内镜下逆行胰胆管造影术对急性胆源性胰腺炎伴胆管炎患者AMS水平及肠功能恢复的影响  

Effects of endoscopic retrograde cholangiopancreatography on serum amylase level and intestinal function recovery in patients with acute biliary pancreatitis complicated with cholangitis

作　　者：金海林[1] 孙仁虎[1] 吴大鹏[1] 袁广众 韩树堂[1] JIN Hailin;SUN Renhu;WU Dapeng;YUAN Guangzhong;HAN Shutang(Digestive Endoscopy Center,Jiangsu Provincial Hospital of Traditional Chinese Medicine,Nanjing 210029,China)

机构地区：[1]江苏省中医院消化内镜中心,江苏南京210029

出　　处：《西部医学》2022年第9期1371-1375,共5页Medical Journal of West China

基　　金：江苏省中医院创新课题资助项目(Y2018CX57)。

摘　　要：目的探究内镜下逆行胰胆管造影术(ERCP)对急性胆源性胰腺炎(ABP)伴胆管炎患者血清淀粉酶(AMS)水平及肠功能恢复的影响。方法选择2016年1月~2021年1月我院收治的ABP伴胆管炎患者110例,对于ABP伴胆管炎患者24 h内进行急诊ERCP术,无法耐受或拒绝ERCP术的患者进行保守治疗,根据治疗方法分为保守治疗组与ERCP组,保守治疗组采用常规保守治疗,ERCP组行ERCP术,对比两组患者治疗前后AMS、血清脂肪酶(LPS)水平变化、肝功能相关指标变化、炎症因子水平变化、胃肠功能恢复时间及临床症状改善时间。结果两组患者治疗第5天AMS、LPS水平均下降,且ERCP组患者治疗第5天AMS、LPS水平均低于保守治疗组(P<0.05);两组患者治疗第5天谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、总胆红素(TBIL)水平均下降,且ERCP组患者治疗第5天上述肝功能指标水平均低于保守治疗组(P<0.05);两组患者治疗第5天白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、C反应蛋白(CRP)及肿瘤坏死因子-α(TNF-α)水平均下降,且ERCP组患者治疗第5天上述炎症因子水平均低于保守治疗组(P<0.05);治疗后ERCP组患者肛门恢复排气时间、初次自行排便时间及开始进食时间均短于保守治疗组(P<0.05);治疗后ERCP组患者腹痛缓解时间、体温恢复正常时间、恶心呕吐消失时间及住院时间均短于保守治疗组(P<0.05)。结论ERCP术可降低患者AMS、LPS水平,减轻对肝功能损伤,降低炎症反应,加快患者胃肠功能恢复速度,有效改善患者临床症状,缩短住院时间。Objective To explore the effects of endoscopic retrograde cholangiopancreatography(ERCP)on serum amylase(AMS)level and intestinal function recovery in patients with acute biliary pancreatitis(ABP)complicated with cholangitis.Methods A total of 110 patients with acute biliary pancreatitis complicated with cholangitis who were treated in our hospital were selected between January 2016 and January 2021.Patients with ABP and cholangitis underwent emergency ERCP within 24 h,and patients who were unable to tolerate or refuse ERCP performed conservative treatment.According to the treatment methods,the patients were divided into conservative treatment group and ERCP group.Conservative treatment group received routine conservative treatment,and ERCP group was given ERCP.The changes in levels of AMS and serum lipase(LPS),liver function-related indicators and inflammatory factors,gastrointestinal function recovery time and clinical symptom improvement time were compared between the two groups before and after treatment.Results The levels of AMS and LPS of the two groups of patients were decreased on the 5^(th) d of treatment,and the levels of AMS and LPS of patients in ERCP group on the 5^(th) d of treatment were lower than those in conservative treatment group(P<0.05).The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(GGT)and total bilirubin(TBIL)on the 5^(th) d of treatment were reduced in the two groups of patients,and the above liver function indicators in ERCP group were lower than those in conservative treatment group on the 5^(th) d of treatment(P<0.05).On the 5^(th) d of treatment,the levels of interleukin-6(IL-6),interleukin-8(IL-8),C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)were decreased in the two groups of patients,and the levels of above inflammatory factors in ERCP group on the 5^(th) d of treatment were lower than those in conservative treatment group(P<0.05).After treatment,the anal exhaust recovery time,first spontaneous defecation time and t

关 键 词：内镜下逆行胰胆管造影术 急性胆源性胰腺炎 胆管炎 血清淀粉酶 肠功能 

分 类 号：R657.45[医药卫生—外科学] R657.51[医药卫生—临床医学]