内镜下乳头括约肌小切开术联合球囊扩张术在轻中度胆源性胰腺炎治疗中的价值

摘要： 目的 探讨应用内镜下乳头括约肌小切开术（sEST）联合球囊扩张术（EPBD）治疗轻中度 胆源性胰腺炎患者的临床疗效。方法 筛选出2013 年1 月-2015 年12 月因轻中度胆源性胰腺炎入住该院 的60 例患者，并随机分为对照组、单纯内镜下乳头括约肌切开术（EST）组和sEST+EPBD 组，每组20 例。 比较分析3 组患者分组当日血清学指标、术后炎症指标、手术并发症、住院情况指标以及随访情况指标。 结果 3 组患者分组当日血清淀粉酶、C 反应蛋白（CRP）及降钙素原（PCT）值比较差异无统计学意义 （P >0.05）。EST 组和sEST+EPBD 组总住院时间明显短于对照组（P <0.05），且sEST+EPBD 组总住院费用明 显低于对照组（P <0.05）；另外，EST 组和sEST+EPBD 组1 年内均无胆源性胰腺炎发生，并均成功实现胆囊 切除，而对照组12 例复发，仅10 例完成胆囊切除。sEST+EPBD 组术后血清淀粉酶水平明显高于EST 组，而 总住院时间、费用以及手术并发症明显低于EST 组（P <0.05）；然而，随访1 年时间内，两组患者均无胆源 性胰腺炎复发，并均最终实现胆囊切除，两组之间无明显差异。结论 sEST+EPBD 是治疗轻中度胆源性胰腺 炎的一种有效的、安全的方法，能减少住院时间及费用，降低术后并发，有利于患者间期实施腹腔镜下胆囊切 除术。
Abstract: Objective To explore the clinical value of sEST+EPBD applied in patients with mild-to-moderate biliary pancreatitis. Methods We selected out 60 cases mild or moderate biliary pancreatitis from January, 2013 to December, 2015, and randomly divided these cases into control group, EST group and sEST + EPBD group. We compared serological indexes, postoperative inflammation index, concurrent operation, hospitalization and follow-up indicators of these three groups. Results The levels of serum amylase, CRP and PCT were no statistical significance in three groups (P > 0.05). Total lengths of hospital stay and recurrence of pancreatitis in EST groups and sEST + EPBD group were significantly shorter than in control group (P < 0.05), and the total cost of hospitalization in sEST + EPBD group was obviously lower than in control group (P < 0.05). The level of postoperative serum amylase in sEST + EPBD group was obviously higher than in EST group, and the total length of hospital stay, cost and operative complications in sEST+EPBD group was significantly lower than that in EST group (P < 0.05); However,within one year, recurrences of pancreatitis and rates of cholecystectomy were no significant differences in these two groups. Conclusion sEST+EPBD is an effective and safe treatment in mild or moderate biliary pancreatitis, and can reduce the length of hospital stay and cost, operative complications, and assist the implementation of interval laparoscopic cholecystectomy.