内镜下逆行胰胆管造影诊治闭合性胰腺外伤临床分析  

Clinical analysis of retrograde endoscopic cholangiopancreatography in the treatment of closed pancreatic trauma

作　　者：郭金坤 周中银[1] GUO Jin-kun;ZHOU Zhong-yin(Department of Gastroenterology&Hubei Provincial Key Laboratory of Digestive Diseases,Renmin Hospital of Wuhan University,430060 Wuhan,China)

机构地区：[1]武汉大学人民医院消化内科、消化系统疾病湖北省重点实验室,湖北武汉430060

出　　处：《临床消化病杂志》2023年第1期46-50,共5页Chinese Journal of Clinical Gastroenterology

摘　　要：[目的]探索内镜下逆行胰胆管造影术(ERCP)对闭合性胰腺外伤的治疗效果,寻找可以预测术后并发症的相关指标。[方法]回顾性分析因闭合性胰腺外伤住院治疗的31例患者的临床资料,31例中20例采取ERCP治疗(ERCP组),11例采取非ERCP治疗(对照组)。比较2组患者胰腺损伤严重程度、术后并发症情况,并采用配对样本t检验分析ERCP组患者生化常规指标水平的变化,采用Logistic回归分析探究各生化水平与患者术后并发症之间的关系。[结果]ERCP组与对照组胰腺损伤程度比较差异无统计学意义。ERCP组胰瘘和胰腺假性囊肿等并发症发生率较对照组更低,而2组创伤性胰腺炎、腹腔出血等并发症发生率比较差异无统计学意义。ERCP组患者降钙素原(PCT)、C反应蛋白、白细胞、血淀粉酶、血脂肪酶等水平在手术前3 d至术后1周有明显变化,术后PCT水平与术后胰瘘之间明显相关,且术后PCT水平每增加1 ng/ml,出现胰瘘的风险增加2.554倍。[结论]ERCP是闭合性胰腺外伤的有效治疗手段,PCT可能是胰腺外伤患者ERCP后胰瘘的预测指标。[Objective]To explore the therapeutic effect of retrograde endoscopic cholangiopancreatography in the treatment of closed pancreatic trauma, and to find relevant indicators that can predict postoperative complications.[Methods]Data of 31 patients who were hospitalized for closed pancreatic trauma in Renmin Hospital of Wuhan University from January 2016 to December 2020,20 of whom were treated with ERCP and 11 with non-ERCP.General information was collected, and the severity of pancreatic injury and postoperative complications were compared between the two groups.Pairedttest was used to analyze the changes in biochemical routine indexes of patients in the ERCP group.Logistic regression analysis was used to explore the relationship between biochemical levels and postoperative complications.[Results]There was no significant difference in the degree of pancreatic injury between the two groups.Compared with the non-ERCP treatment group, the incidence of complications such as pancreatic fistula and pancreatic pseudocyst was lower in the ERCP treatment group, while there was no statistically significant difference in the incidence of complications such as traumatic pancreatitis and abdominal hemorrhage.In the ERCP treatment group, the levels of procalcitonin, C-reactive protein, white blood cells, blood amylase, and blood lipase significantly changed from 3 days before operation to 1 week after operation.Postoperative PCT level was significantly correlated with postoperative pancreatic fistula, and the risk of postoperative pancreatic fistula increased by 2.554 times for every 1 ng/mL increase in postoperative PCT level.[Conclusion]ERCP is an effective treatment for closed pancreatic trauma, and PCT may be a predictor of pancreatic fistula after ERCP in patients with pancreatic trauma.

关 键 词：内镜下逆行胰胆管造影术 闭合性胰腺外伤 胰瘘 降钙素原 

分 类 号：R814.43[医药卫生—影像医学与核医学]