胰管支架治疗重症急性胰腺炎的疗效观察  

Effect of pancreatic duct stenting in the treatment of severe acute pancreatitis:a retrospective study in a single center

作　　者：刘迪[1] 赵成思 姚维杰 陈安宁 杨小娟[3] 杨晓军[3] 白慧[4] 黄李雅[5] 王佐正[1] Liu Di;Zhao Chengsi;Yao Weijie;Chen Anning;Yang Xiaojuan;Yang Xiaojun;Bai Hui;Huang Liya;Wang Zuozheng(Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Manchester University,Manchester M156JH,Britain;Department of Critical Medicine,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Pharmacy,General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Gastroenterology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院肝胆外科,银川750004 [2]曼彻斯特大学,曼彻斯特M156JH [3]宁夏医科大学总医院重症医学科,银川750004 [4]宁夏医科大学总医院药剂科,银川750004 [5]宁夏医科大学总医院消化内科,银川750004

出　　处：《中华肝胆外科杂志》2023年第8期594-598,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：宁夏自治区高层次科技创新领军人才(2021GKLRLX04);宁夏回族自治区中央引导地方科技发展专项(2023FRD05009);宁夏回族自治区卫生健康系统科研课题(2023-NWKYT-021)。

摘　　要：目的评价胰管支架治疗重症急性胰腺炎(SAP)的临床疗效。方法回顾性分析2019年1月1日至2020年7月1日宁夏医科大学总医院肝胆外科收治的68例SAP患者的临床资料,其中男性38例,女性30例,年龄(44.85±8.51)岁。根据治疗方式分为两组:采用常规保守治疗的患者为保守组(n=41),在保守治疗基础上行胰管支架置入术的患者为支架组(n=27)。收集患者的一般资料、肠外营养支持时间、禁食天数等临床资料。比较两组患者入院时及治疗后48 h的血清淀粉酶、白细胞计数、急性生理与慢性健康(APACHE)II评分和CT评分。结果与治疗前相比,两组患者治疗后的血清淀粉酶、白细胞计数、APACHE II评分和CT评分均降低,差异具有统计学意义(均P<0.05)。与保守组相比,支架组患者治疗后的APACHE II评分[(5.52±2.15)分比(8.76±2.50)分]和CT评分[(4.85±1.96)分比(6.18±1.07)分]均降低,差异具有统计学意义(均P<0.05)。27例支架组患者均成功置入胰管支架,1例患者术中主胰管插管失败,采取经副乳头插管最终放置副胰管支架,所有患者未发生内镜逆行胰胆管造影术后胰腺炎、出血穿孔等严重并发症。与保守组相比,支架组患者术后发生局部并发症的比例[18.52%(5/27)比41.46%(17/41)]及抗生素使用种类>3种的比例[29.63%(8/27)比56.10%(23/41)]均降低,镇痛次数减少[2(1,3)次比4(3,6)次],抗生素使用时间[8(3,11)d比13(10,19)d]、肠外营养时间[7(4,15)d比15(8,18)d]、禁食时间[5(3,11)d比11(6,13)d]及住院时间[10(5,16)d比15(13,23)d]均缩短,差异均具有统计学意义(均P<0.05)。结论保守治疗和胰管支架治疗均可缓解SAP患者的临床症状,但胰管支架治疗在改善症状、缩短住院时长、降低局部并发症等方面更优。Objective To evaluate the effect of pancreatic duct stenting in the treatment of severe acute pancreatitis(SAP).Methods The clinical data of 68 patients with SAP admitted to the Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University from January,2019 to July,2020 were retrospectively analyzed,including 38 males and 30 females,aged(44.85±8.51)years old.The patients were divided into two groups according to the treatment modality:the conservative group(n=41)which received the conservative management,and the stent group(n=27)which underwent pancreatic duct stent implantation and conservative management.The basic information,parenteral nutrition support time,fasting days,and other clinical data of patients were collected.Serum amylase,white blood cell count,acute physiology and chronic health(APACHE)II score and CT score were compared between the two groups at admission and 48 hours after treatment.Results The serum amylase,white blood cell count,APACHE II score and CT score of the two groups were significantly lower after treatment(all P<0.05).Compared with the conservative group,the APACHE II score[(5.52±2.15)vs.(8.76±2.50)]and CT score[(4.85±1.96)vs.(6.18±1.07)]of patients were lower in the stent group after treatment(both P<0.05).Pancreatic duct stents were successfully implanted in all 27 patients of the stent group.Intubation to the main pancreatic duct failed in one patient,while the accessory pancreatic duct was alternatively intubated through the accessory nipple.No severe complications such as iatrogenic pancreatitis,bleeding,and perforation occurred after endoscopic retrograde cholangiopancreatography.The incidence of postoperative local complications was lower[18.52%(5/27)vs.41.46%(17/41)],the proportion of antibiotic use>3 types[29.63%(8/27)vs.56.10%(23/41)]decreased,and the analgesic episodes decreased[2(1,3)vs.4(3,6)]in the stent group.The antibiotic usage duration[8(3,11)d vs.13(10,19)d],the parenteral nutrition time[7(4,15)d vs.15(8,18)d],the fasting time[5(3,11)d vs.

关 键 词：胰腺炎 内镜逆行胰胆管造影 支架 治疗 

分 类 号：R657.51[医药卫生—外科学]