早期内镜治疗急性胆源性胰腺炎的疗效和安全性(1)
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[摘要] 目的 探讨急性胆源性胰腺炎患者早期行治疗性内镜逆行胰胆管照影(ERCP)的疗效和安全性。 方法 选择2007年10月~2010年10月我院符合急性胆源性胰腺炎诊断标准的患者62例，将其分为内镜组(行内镜治疗)38例和对照组(内科保守治疗)24例，观察两组患者的腹痛缓解时间、血淀粉酶恢复时间、住院时间等，评估其疗效和安全性。 结果 内镜组治疗成功36例，成功率为94.7%，腹痛缓解时间、住院天数、血淀粉酶恢复速度均显著低于对照组(P < 0.05、P < 0.01)，内镜治疗未见严重并发症发生，未有死亡病例。 结论 早期内镜治疗急性胆源性胰腺是微创、安全、有效、快速的治疗手段，可降低病死率，减少患者的住院时间。
[关键词] 急性胆源性胰腺炎；逆行胆胰管照影
[中图分类号] R576 [文献标识码] B [文章编号] 1673-7210(2012)02(b)-0154-03
Efficacy and safety of early endoscopic therapy for acute biliary pancreatitis
ZHANG Lifen SHEN Chunyan
The Seventh People's Hospital of Shanghai City, Shanghai 200137, China
[Abstract] Objective To investigate the therapeutic effect of duodenoscopy in the early treatment of acute biliary pancreatitis (ABP). Methods 62 patients with ABP of our hospital from October 2007 to October 2010 were selected, 38 patients endoscopic group) with ABP received emergent endoscopic retrograde cholongiopancreatography (ERCP), sphinctemtomy (EST) plus endoscopic lithotomy and endoscopic nasobiliary drainage (ENBD). Other 24 cases (control group) were treated with conservative therapy. The remission duration of abdominal pain, serum amylase recovery rate, hospitalization of two groups were observed, which were assessed efficacy and safety in two groups. Results There were 36 cases were cure, the successful rate of endoscopic management was 94.7%. There was no one had severe complications nor mortality. The duration of symptoms, hospitalization and serum amylase recovery rate in endoscopy group were significantly shorter than that of control group (P < 0.05, P < 0.01). Conclusion Endoscopy technology in the treatment of acute biliary pancreatitis is mini-invasive, safe and effective, and can reduce mortality and hospitalization.
[Key words] Acute biliary pancreatitis; ERCP
因胆石症及急性胆道感染等胆道疾病引起的急性胰腺炎称为急性胆源性胰腺炎(acute biliary pancreatitis，ABP)，是引起急性胰腺炎的主要病因，占其发病率的40%~60%[1]。20世纪80年代急性胆源性胰腺炎行内镜逆行胰胆管造影(endoscopic retrograde cholangio pancreatography，ERCP)和十二指肠乳头括约肌切开术(endoscopic sphincterotomy，EST)开始在临床实践中开展，给患者带来新的曙光，但在20多年的临床研究中，急性胆源性胰腺炎患者内镜干预的早期使用仍然存在争议[1-2] ......
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