摘要
背景与目的:急性胆源性胰腺炎(ABP)是临床上一种常见疾病,最常见的原因为胆总管结石。目前国内主流观点认为,对于发病早期的ABP应尽早进行镜逆行胰胆管造影(ERCP)联合内镜乳头括约肌切开术(EST)诊疗,然而,近期的文献及指南表明ERCP联合EST并非适用于所有的ABP患者。针对这一问题,本研究旨在进一步探讨ERCP联合EST治疗ABP的临床价值及其临床适应证。方法:回顾性分析2016年1月—2019年1月因ABP收治的107例患者临床资料。其中47例采取保守治疗,另60例在保守治疗的基础上,于入院后72 h内实施ERCP联合EST治疗,比较两种治疗方式之间的疗效差异。结果:整体分析结果显示,ERCP联合EST治疗在腹痛缓解时间、CRP恢复时间以及血淀粉酶恢复时间方面明显优于保守治疗(均P<0.05)。进一步亚组分析显示,对于伴有急性胆管炎的ABP患者,ERCP联合EST治疗在腹痛缓解时间、白细胞恢复时间、CRP恢复时间、血淀粉酶恢复时间以及平均住院时间均明显优于保守治疗(均P<0.05);但对于不伴急性胆管炎的ABP,ERCP联合EST治疗组各观察指标均无明显优势(均P>0.05)。无论是整体分析还是亚组分析,ERCP联合EST治疗费用均明显高于治疗费用(均P<0.05),而两种治疗方式的并发症发生率均无统计学差异(均P>0.05)。结论:ERCP联合EST治疗ABP相比保守治疗而言具有一定优势,尤其对于伴有急性胆管炎的ABP效果确切;但对于不伴胆管炎的ABP,ERCP联合EST治疗较保守治疗并无明显优势,却增加住院费用。因此,临床中需对患者病情进行综合分析,不可一概而论,建议遵循个体化治疗方案。
Background and Aims:Acute biliary pancreatitis(ABP)is a common disease and its most common cause is choledocholithiasis.At present,the mainstream view in China is that endoscopic retrograde cholangiopancreatography(ERCP)combined with endoscopic sphincterotomy(EST)should be performed as early as possible for diagnosis and treatment of the early-onset ABP.However,the recent literature and guidelines demonstrated that ERCP combined with EST are not suitable for all ABP patients.Therefore,concerning this issue,this study was conducted to further investigate the clinical value and clinical indications of ERCP plus EST in treatment of ABP.Methods:The clinical data of 107 patients admitted for ABP from January 2016 to January 2019 were retrospectively analyzed.Of the patients,47 cases underwent conservative treatment,and the other 60 cases received ERCP plus EST within 72 h of admission on the basis of conservative treatment.The clinical efficacy variables of the two treatment methods were compared.Results:Results of the overall analysis showed that ERCP plus EST was significantly superior to conservative treatment in terms of abdominal pain relief time,CRP recovery time and blood amylase recovery time(all P<0.05).Further subgroup analysis indicated that ERCP plus EST was significantly better than conservative treatment in abdominal pain relief time,leukocyte recovery time,CRP recovery time,blood amylase recovery time and average hospitalization time for ABP patients with concomitant acute cholangitis(all P<0.05),but had no obvious advantages over conservative treatment in each observed variable for ABP patients without acute cholangitis(all P>0.05).In either overall analysis or subgroup analysis,the hospitalization costs of ERCP plus EST were significantly higher than those of conservative treatment(all P<0.05),while no significant differences in the incidence rates of complications were noted between the two treatment methods(all P>0.05).Conclusion:For ABP,ERCP plus EST has certain advantages over conservative treatme
作者
杨文
李修红
YANG Wen;LI Xiuhong(Department of Hepatobiliary Surgery,The People’s Hospital of Dazu District Chongqing,Chongqing 402360,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2020年第9期1119-1125,共7页
China Journal of General Surgery
基金
重庆市大足区科委科技计划基金资助项目(DZKJ,2017ACC1013)。
关键词
胰腺炎
胰胆管造影术
内窥镜逆行
括约肌切开术
内窥镜
胆管炎
Pancreatitis
Cholangiopancreatography,Endoscopic Retrograde
Sphincterotomy,Endoscopic
Cholangitis
