目的 探讨在早期重症急性胆源性胰腺炎(severe acute biliary pancreatitis， SABP)内镜逆行胆胰管造影术(endoscopic retrograde cholangiopancreatography， ERCP)的治疗价值。方法 2011-07至2015-07我科收治的SABP患者经知情同意后分为早期内镜治疗组(EEI)和早期非手术治疗组(ECM)，每组43例;比较两组治疗前后白细胞计数(WBC)、中性粒细胞百分比值(N%)，总胆红素(TBIL)、白细胞介素6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)变化，腹痛缓解时间、住院时长、器官衰竭发生率的区别。结果 EEI组与ECM组相比，平均住院天数[(24.8±4.8)d vs (28.3±6.1)d]明显减少，器官衰竭总发生率(30.2% vs 53.5%)明显降低，1周内腹痛缓解率(83.7% vs 60.4%)更高(P＜0.05)。ECM组胰腺感染坏死发生率较EEI组有增高趋势(P=0.062)。EEI组患者ERCP治疗后WBC、N%、IL-6、TBIL较入院时明显降低(P<0.05)，1周后N%、PCT、IL-6、CRP、TBIL进一步下降(P<0.05)。ECM组治疗72 h未能使WBC、N%、PCT、IL-6、CRP、TBIL下降，予以ERCP治疗后WBC、N%、IL-6、TBIL明显降低(P＜0.05);部分未行介入治疗的ECM患者治疗1周后N%、PCT、IL-6、CRP无明显降低。ERCP治疗患者未见相关并发症。结论 在SABP综合治疗中，早期予以ERCP治疗安全、有效、可行，可改善临床症状、指标，缩短病程，使患者早日康复。
Abstract
Objective To assess the efficacy of early endoscopic retrograde cholangiopancreatography (ERCP) in the management of severe acute biliary pancreatitis (SABP) compared with conservative treatment.Methods SABP patients were divided into early endoscopic intervention group (EEI) and early conservative management group (ECM) after informed consent from July 2011 to July 2015 in this department. The following indexes, such as the white blood cell count (WBC), neutrophil percentage (N%), total bilirubin (TBIL), interleukin 6 (IL-6), C-reactive protein (CRP), calcitonin (PCT), abdominal pain relief time, duration of hospitalization and incidence of organ failure were compared between the two groups.Results The average duration of hospitalization[ (24.8±4.8)d vs (28.3±6.1)d] and the incidence of organ failure (30.2% vs 53.5%) in the EEI group were significantly lower than that in the ECM group, and the pain relief rate (83.7% vs 60.4%) was higher in the EEI group (P<0.05). The incidence of necrotic infection of the pancreas in ECM group was likely higher than that in EEI group (P=0.062). Indexes of WBC, N%, IL-6 and TBIL significantly decreased after ERCP intervention in the EEI group, and N%, PCT, IL-6, CRP and TBIL were lower after 1 week of treatment than that of post-ERCP. ECM group failed to decrease the indexes of WBC, N%, PCT, IL-6, CRP and TBIL after conservative treatment for 72 h. Patients undergoing ERCP in ECM group had significantly lower WBC, N%, IL-6 and TBIL than the indexes of 72 h after admission (P<0.05). Patients treated after 1 week without ERCP had no changes in N% PCT, IL-6 and CRP. ERCP related complications were not seen in both groups.Conclusions ERCP intervention in the early stage of SABP is safe, effective and feasible, and it can improve clinical symptoms and indexes, shorten the course of disease, and promote the recovery of SABP patients.
关键词
重症急性胆源性胰腺炎 /
内镜逆行胆胰管造影术 /
治疗效果
Key words
severe acute biliary pancreatitis /
endoscopic retrograde cholangiopancreatography /
curative effect
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 中华医学会消化内镜分会ERCP学组. 内镜下逆行胆胰管造影术(ERCP)诊治指南(2010版)[J]. 中国继续医学教育, 2010, 2(6): 1-20.
[2] Van Geenen E J, Van Santvoort H C, Besselink M G, et al. Lack of consensus on the role of endoscopic retrograde cholangiography in acute biliary pancreatitis in published meta-analyses and guidelines: a systematic review[J]. Pancreas, 2013, 42(5): 774-780.
[3] Chen P, Hu B, Wang C, et al. Pilot study of urgent endoscopic intervention without fluoroscopy on patients with severe acute biliary pancreatitis in the intensive care unit[J]. Pancreas, 2010, 39(3): 398-402.
[4] 邱昌福, 董家刚, 李生伟, 等. 重症急性胆源性胰腺炎早期内镜治疗的疗效分析[J]. 中华内分泌外科杂志, 2010, 4(3): 213-214.
[5] 唐悦锋, 徐杨荣, 廖国庆. 早期内镜治疗在重症急性胆源性胰腺炎治疗中的作用[J]. 中国普通外科杂志, 2010, 19(7): 801-804.
[6] 谢子英, 孙大勇, 王卫卫, 等. 内镜治疗急诊高龄急性重症胆源性胰腺炎80例分析[J]. 临床军医杂志, 2011, 39(5): 897-899.
[7] 易晓彤. 应用治疗性逆行胆胰管造影对重症急性胆源性胰腺炎的诊治与疗效观察[J]. 贵阳中医学院学报, 2012, 34(5): 150-152.
[8] 钟玉川, 崔乃强. 早期非手术治疗与早期内镜治疗在胆源性重症急性胰腺炎中的疗效比较[J]. 中国中西医结合外科杂志, 2013, 19(4): 361-364.
[9] 中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会, 中华消化杂志编辑委员会. 中国急性胰腺炎诊治指南(20 1 3年, 上海)[J]. 中华消化杂志, 2013, 33(4): 217-222.
[10] 陈幼祥. 胆源性胰腺炎的诊断和治疗[J]. 中国实用内科杂志, 2014, 34(9): 843-846.
[11] Malledant Y, Malbrain M L, Reuter D A. What’s new in the management of severe acute pancreatitis?[J]. Intensive Care Med, 2015, 41(11): 1957-1960.
[12] 张太平, 曹 喆, 赵玉沛. 急性胰腺炎的诊断与处理: 国内外主要指南的比较与解读[J]. 临床肝胆病杂志, 2014, 30(8): 712-715.
[13] Petrov M S, Van Santvoort H C, Besselink M G, et al. Early endoscopic retrograde cholangiopancreatography versus conservative management in acute biliary pancreatitis without cholangitis: a meta-analysis of randomized trials [J]. Ann Surg, 2008, 247(2): 250-257.
[14] Tse F, Yuan Y. Early routine endoscopic retrograde cholangiopancreatography strategy versus early conservative management strategy in acute gallstone pancreatitis[J]. Cochrane Database Syst Rev, 2012, 5: CD009779.
[15] Takada T, Hirata K, Mayumi T, et al. Cutting-edge information for the management of acute pancreatitis[J]. J Hepatobiliary Pancreat Sci, 2010, 17(1): 3-12.
[16] Takada T. JPN guidelines 2010. Foreword[J]. J Hepatobiliary Pancreat Sci, 2010, 17(1): 1-2.
[17] Mayumi T, Takada T, Hirata K, et al. Pancreatitis bundles[J]. J Hepatobiliary Pancreat Sci, 2010, 17(1): 87-89.
[18] Kimura Y, Arata S, Takada T, et al. Gallstone-induced acute pancreatitis[J]. J Hepatobiliary Pancreat Sci, 2010,17(1): 60-69.
[19] Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis[J]. Am J Gastroenterol, 2013, 108(9): 1400-1416.
[20] Anderloni A, Repici A. Role and timing of endoscopy in acute biliary pancreatitis[J]. World J Gastroenterol, 2015, 21(40): 11205-11208.
[21] 莫 晨,孙 刚,张 丽,等.早期ERCP与早期保守治疗重症急性胆源性胰腺炎的系统综述及Meta分析[J]. 世界华人消化杂志,2015,23(5):813-822.
PDF(685 KB)
