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非梗阻性急性胆源性胰腺炎行ERCP/ES的临床意义

Keywords: 急性胆源性胰腺炎,内镜逆行胰胆管造影,内镜括约肌切开术

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Abstract:

目的探讨非梗阻性急性胆源性胰腺炎(acutebiliarypancreatitis,ABP)患者急诊行逆行胰胆管造影和Oddi括约肌切开术(endoscopicretrogradecholangiopancreaticographyandendoscopicsphincterotomy,ERCP/ES)治疗的效果和价值。方法142例ABP患者中,轻型急性胆源性胰腺炎(mildacutebiliarypancreatitis,MABP)93例,非梗阻性重症急性胆源性胰腺炎(severeacutebiliarypancreatitis,SABP)49例。MABP和SABP各随机分为ERCP/ES治疗组和保守治疗组。保守治疗组常规行液体复苏、抑酸、抑酶、保肝、防治感染、早期肠内营养和中药等治疗,ERCP/ES组则在保守治疗基础上于入院24h内急诊行ERCP/ES。MABP和SABP分别比较ERCP/ES和保守治疗的效果,并随访2~3年比较胰腺炎的复发率。结果MABP急诊行ERCP/ES与相应保守治疗组比较,ΔAPACHEⅡ、腹痛缓解时间、总住院时间、并发症发生率、病死率差异均无统计学意义(P>0.05),但胰腺炎复发率ERCP/ES较保守治疗组降低(P<0.01)。SABP急诊行ERCP/ES与相应保守治疗组比较,ΔAPACHE、缓解腹痛、住院时间、并发症、病死率和胰腺炎的复发率差异均有统计学意义(均P<0.05或P<0.01)。结论MABP急诊行ERCP/ES,对其并发症、病死率和预后等无明显益处,并有增加相关并发症的风险,而SABP急诊行ERCP/ES可显著改善病情,缩短住院时间,降低并发症和病死率。ABP行ERCP/ES可降低胰腺炎复发率。

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