摘要
目的分析早期梗阻型急性胆源性胰腺炎(ABP)患者应用不同治疗方法治疗的效果。方法回顾性分析安徽医科大学附属安庆医院2013年7月至2015年1月收治的60例梗阻型ABP患者临床资料,根据不同治疗方法分为非手术治疗组、开腹手术组和内镜下十二指肠乳头括约肌切开术(EST)治疗组,每组20例;依据Ranson标准及APACHEⅡ评分,将患者分为轻型组(34例)及重型组(26例)。对比各组患者住院时间、腹痛缓解时间、血淀粉酶恢复时间、病死率、半年内胰腺炎复发率及胰腺炎并发症发生情况。结果轻型组患者比较:非手术治疗组住院时间、腹痛缓解时间及血淀粉酶恢复时间均长于开腹手术组、EST治疗组(P均<0.05),而开腹手术组和EST治疗组比较差异无统计学意义(P均>0.05)。重型组患者比较:非手术治疗组住院时间、腹痛缓解时间及血淀粉酶恢复时间均长于开腹手术组、EST治疗组(P均<0.05),且开腹手术组均长于EST治疗组(P均<0.05)。非手术治疗组患者死亡率为15.0%,开腹手术组为5.0%,EST治疗组为5.0%,3组患者死亡率比较差异无统计学意义(P>0.05)。开腹手术组患者并发症发生率、胰腺炎复发率均低于非手术治疗组(P均<0.05);EST治疗组并发症发病率、胰腺炎复发率均低于非手术治疗组,均高于开腹手术组,但差异均无统计学意义(P均>0.05)。结论梗阻型ABP患者非手术治疗后,须早期行开腹手术或EST解决胆道梗阻。同时,对于早期胆道手术方式的选择,需根据患者实际疾病及机体应激状态、年龄等综合因素做出科学选择,以便进行针对性治疗,促进患者预后康复。
Objective To analyze the efficacy of early different treatment methods in patients with obstructive acute biliary pancreatitis（ ABP）. Methods The clinical data of 60 patients with obstructive ABP who were treated in Anqing hospital affiliated to Anhui medical university from July 2013 to January 2015 were retrospectively analyzed. According to the treatment methods,the patients were divided into non-surgical treatment group,laparotomy group,endoscopic sphincterotomy（ EST） treatment group（ n = 20 each）. Based on Ranson score and acute physiology and chronic health evaluation（ APACHE Ⅱ） score,the patients were divided into mild type group（ n = 34） and severe type group（ n = 26）. Hospital stay,time of abdominal pain relief and time coming back to normal level of serum amylase,mortality rate,recurrent rate and complications of pancreatitis in half a year were compared in different groups. Results For mild type group,the hospital stay,the time of abdominal pain relief and the time of serum amylase recovery in non-surgical treatment group were significantly longer than those in laparotomy group and EST group（ all P 〈0. 05）,and there was no statistical difference between laparotomy group and EST group（ P 〈0. 05）. For severe type group,the hospital stay,the time of abdominal pain relief and the time of serum amylase recovery in non-surgical treatment group were significantly longer than those in laparotomy group and EST group（ all P 〈0. 05）,which in laparotomy group were significantly longer than those in EST group（ all P 〈0. 05）.There was no significant difference in mortality rates among non-surgical treatment group,laparotomy group and EST treatment group（ 15. 0% vs 5. 0% vs 5. 0%,P 〈0. 05）. The incidence of complications and recurrence rate of pancreatitis in laparotomy group were significantly lower than those in non-surgical treatment group（ all P 〈0. 05）,and the incidence of complications and recurrence rate of pancreatitis in EST group were lower than
出处
《中国临床研究》
CAS
2016年第3期324-327,共4页
Chinese Journal of Clinical Research
基金
安徽医科大学科研基金资助(2015xkj148)
