目的 評價入院72 h內(nèi)行內(nèi)鏡逆行胰膽管造影(endoscopic retrograde cholangiopancreatography,ERCP)及介入治療急性膽源性胰腺炎(acute biliary pancreatitis,ABP)的安全性和療效。
方法 將我院2007年1月至2009年6月期間收治的87例ABP住院患者按治療方式分為內(nèi)鏡治療組和保守治療組,內(nèi)鏡治療組行ERCP檢查和介入治療,保守治療組行常規(guī)內(nèi)科保守治療,分別觀察2組的腹痛緩解時間、住院時間、血淀粉酶恢復(fù)時間、血白細胞恢復(fù)時間及肝功能恢復(fù)時間,并觀察其并發(fā)癥發(fā)生情況。
結(jié)果 內(nèi)鏡治療組患者腹痛緩解時間、住院時間、血淀粉酶恢復(fù)時間、血白細胞恢復(fù)時間和肝功能恢復(fù)時間均明顯短于保守治療組(P lt;0.05)。未發(fā)生與內(nèi)鏡操作有關(guān)的消化道大出血、消化道穿孔、心血管意外等嚴重并發(fā)癥。未見因ERCP檢查和介入治療而使病情加重者。
結(jié)論 早期內(nèi)鏡介入治療ABP安全、有效,能防止病情進一步發(fā)展。
引用本文: 王健,杜波,胡兵,謝志華,但杰,鐘顯飛. 內(nèi)鏡介入治療急性膽源性胰腺炎的臨床研究. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(9): 970-973. doi: 復(fù)制
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1. | Schietroma M, Lattanzio R, Risetti A, et al. Diagnosis of severity as a basic parameter in the treatment of acute biliary pancreatitis [J]. Minerva Chir, 2000; 55(6): 421429. |
2. | Uomo G, Slavin J. Endoscopic sphincterotomy for acute pancreatitis: arguments in favour [J]. Ital J Gastroenterol Hepatol, 1998; 30(5): 557561. |
3. | 中華醫(yī)學會消化病學分會胰腺疾病學組. 中國急性胰腺炎診治指南(草案) [J]. 中華內(nèi)科雜志, 2004; 43(3): 236238. |
4. | Cohen S, Bacon BR, Berlin JA, et al. National Institutes of Health StateoftheScience Conference Statement: ERCP for diagnosis and therapy, January 1416, 2002 [J]. Gastrointest Endosc, 2002; 56(6): 803809. |
5. | Working Party of the British Society of Gastroenterology; Association of Surgeons of Great Britain and Ireland; Pancreatic Society of Great Britain and Ireland; Association of Upper GI Surgeons of Great Britain and Ireland. UK guidelines for the management of acute pancreatitis [J]. Gut, 2005; 54(Suppl Ⅲ): Ⅲ1Ⅲ19. |
6. | 中華醫(yī)學會消化病學分會胰腺疾病學組. 中國急性胰腺炎診治指南(草案) [J]. 中華消化雜志, 2004; 24(3): 190192. |
7. | 張志功, 朱化剛, 孟翔凌, 等. APACHEⅡ、RANSON 評分在重癥急性胰腺炎中的應(yīng)用價值 [J]. 肝膽外科雜志, 2005; 13(1): 3235. |
8. | 孫明. 內(nèi)科治療學 [M]. 第12版. 北京: 人民衛(wèi)生出版社, 2006: 352354. |
9. | 鄭芝田. 胃腸病學 [M]. 北京: 人民衛(wèi)生出版社, 2000: 13781379. |
10. | Forsmark CE. The clinical problem of biliary acute necrotizing pancreatitis: epidemiology, pathophysiology, and diagnosis of biliary necrotizing pancreatitis [J]. J Gastrointest Surg, 2001; 5(3): 235239. |
11. | van Brummelen SE, Venneman NG, van Erpecum KJ, et al. Acute idiopathic pancreatitis: does it really exist or is it a myth? [J]. Scand J Gastroenterol Suppl, 2003; (239): 117122. |
12. | Kaiser AM, Saluja AK, Steer ML. Repetitive shortterm obstructions of the common bilepancreatic duct induce severe acute pancreatitis in the opossum [J]. Dig Dis Sci, 1999; 44(8): 16531661. |
13. | 張肇達, 田伯樂. 急性膽源性胰腺炎 [J]. 中華肝膽外科雜志, 2002; 8(2): 93. |
14. | 李學謙, 江堤, 顧紅祥, 等. ERCP相關(guān)技術(shù)治療胰膽道疾病219例臨床分析 [J]. 贛南醫(yī)學院學報, 2008; 28(4): 520521. |
15. | Pezzilli R, Billi P, MorselliLabate AM, et al. Anesthesiological risk and endoscopic sphincterotomy in acute biliary pancreatitis [J]. Pancreas, 2003; 26(4): 334338. |
16. | 袁耀宗. 胰腺病學新進展與新技術(shù) [M]. 上海: 上??茖W技術(shù)文獻出版社, 2001: 324325. |
17. | Schietroma M, Carlei F, Lezoche E, et al. Acute biliary pancreatitis: staging and management [J]. Hepatogastroenterology, 2001; 48(40): 988993. |
18. | 李兆申. 膽胰疾病的內(nèi)鏡治療 [J]. 中國實用外科雜志, 2005; 25(6): 326328. |
19. | 萬偉, 吳小鵬, 唐艷. LC術(shù)聯(lián)合EST術(shù)治療膽囊及膽總管結(jié)石12例 [J]. 中國現(xiàn)代普通外科進展, 2005; 8(3): 156. |
20. | Arnold JC, Benz C, Martin WR, et al. Endoscopic papillary balloon dilation vs. sphincterotomy for removal of common bile duct stones: a prospective randomized pilot study [J]. Endoscopy, 2001; 33(7): 563567. |
21. | 李兆申. 積極開展急性膽源性胰腺炎的內(nèi)鏡治療 [J]. 胰腺病學, 2002; 2(2): 6567. |
22. | 張奇, 孫備. 梗阻型膽源性胰腺炎內(nèi)鏡治療時機的選擇 [J]. 中國普通外科雜志, 2008; 17(3): 203206. |
23. | 張圣道, 雷若慶. 國際胰腺病學會《急性胰腺炎外科處理指南》介紹及相關(guān)討論 [J]. 肝膽胰外科雜志, 2003; 15(2): 133134. |
24. | 于瀾, 姚欣敏, 胡先典, 等. 經(jīng)內(nèi)鏡治療急性膽源性胰腺炎30例報道 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(4): 396398. |
25. | Fan ST, Lai EC, Mok FP, et al. Early treatment of acute biliary pancreatitis by endoscopic papillotomy [J]. N Engl J Med, 1993; 328(4): 228232. |
26. | CarrLocke DL. Biliary pancreatitis [J]. Can J Gastroenterol, 2003; 17(3): 205208. |
27. | Ayub K, Imada R, Slavin J. Endoscopic retrograde cholangiopancreatography in gallstoneassociated acute pancreatitis [J]. Cochrane Database Syst Rev, 2004; (4): CD003630. |
28. | Schietroma M, Lattanzio R, Risetti A, et al. Treatment of acute biliary pancreatitis in the aged in the endolaparoscopic era [J]. Minerva Chir, 1999; 54(10): 677684. |
29. | Forssmann K, Singer MV.How to proceed? ERCP in acute pancreatitis? [J]. Praxis (Bern 1994), 1999; 88(12): 1317. |
30. | Jover R, Llach J, Bordas JM, et al. The usefulness of the timeliness of endoscopic sphincterotomy in severe acute pancreatitis of biliary origin [J]. Gastroenterol Hepatol, 1997; 20(7): 344346. |
31. | Farinon AM. Acute biliary pancreatitis [J]. Ann Ital Chir, 1998; 69(6): 751763. |
32. | 林爭, 譚國鉗, 雷朝暉. 早期內(nèi)鏡膽總管Oddi括約肌切開術(shù)治療急性膽源性胰腺炎 [J]. 中國內(nèi)鏡雜志, 2003; 9(8): 3537. |
- 1. Schietroma M, Lattanzio R, Risetti A, et al. Diagnosis of severity as a basic parameter in the treatment of acute biliary pancreatitis [J]. Minerva Chir, 2000; 55(6): 421429.
- 2. Uomo G, Slavin J. Endoscopic sphincterotomy for acute pancreatitis: arguments in favour [J]. Ital J Gastroenterol Hepatol, 1998; 30(5): 557561.
- 3. 中華醫(yī)學會消化病學分會胰腺疾病學組. 中國急性胰腺炎診治指南(草案) [J]. 中華內(nèi)科雜志, 2004; 43(3): 236238.
- 4. Cohen S, Bacon BR, Berlin JA, et al. National Institutes of Health StateoftheScience Conference Statement: ERCP for diagnosis and therapy, January 1416, 2002 [J]. Gastrointest Endosc, 2002; 56(6): 803809.
- 5. Working Party of the British Society of Gastroenterology; Association of Surgeons of Great Britain and Ireland; Pancreatic Society of Great Britain and Ireland; Association of Upper GI Surgeons of Great Britain and Ireland. UK guidelines for the management of acute pancreatitis [J]. Gut, 2005; 54(Suppl Ⅲ): Ⅲ1Ⅲ19.
- 6. 中華醫(yī)學會消化病學分會胰腺疾病學組. 中國急性胰腺炎診治指南(草案) [J]. 中華消化雜志, 2004; 24(3): 190192.
- 7. 張志功, 朱化剛, 孟翔凌, 等. APACHEⅡ、RANSON 評分在重癥急性胰腺炎中的應(yīng)用價值 [J]. 肝膽外科雜志, 2005; 13(1): 3235.
- 8. 孫明. 內(nèi)科治療學 [M]. 第12版. 北京: 人民衛(wèi)生出版社, 2006: 352354.
- 9. 鄭芝田. 胃腸病學 [M]. 北京: 人民衛(wèi)生出版社, 2000: 13781379.
- 10. Forsmark CE. The clinical problem of biliary acute necrotizing pancreatitis: epidemiology, pathophysiology, and diagnosis of biliary necrotizing pancreatitis [J]. J Gastrointest Surg, 2001; 5(3): 235239.
- 11. van Brummelen SE, Venneman NG, van Erpecum KJ, et al. Acute idiopathic pancreatitis: does it really exist or is it a myth? [J]. Scand J Gastroenterol Suppl, 2003; (239): 117122.
- 12. Kaiser AM, Saluja AK, Steer ML. Repetitive shortterm obstructions of the common bilepancreatic duct induce severe acute pancreatitis in the opossum [J]. Dig Dis Sci, 1999; 44(8): 16531661.
- 13. 張肇達, 田伯樂. 急性膽源性胰腺炎 [J]. 中華肝膽外科雜志, 2002; 8(2): 93.
- 14. 李學謙, 江堤, 顧紅祥, 等. ERCP相關(guān)技術(shù)治療胰膽道疾病219例臨床分析 [J]. 贛南醫(yī)學院學報, 2008; 28(4): 520521.
- 15. Pezzilli R, Billi P, MorselliLabate AM, et al. Anesthesiological risk and endoscopic sphincterotomy in acute biliary pancreatitis [J]. Pancreas, 2003; 26(4): 334338.
- 16. 袁耀宗. 胰腺病學新進展與新技術(shù) [M]. 上海: 上??茖W技術(shù)文獻出版社, 2001: 324325.
- 17. Schietroma M, Carlei F, Lezoche E, et al. Acute biliary pancreatitis: staging and management [J]. Hepatogastroenterology, 2001; 48(40): 988993.
- 18. 李兆申. 膽胰疾病的內(nèi)鏡治療 [J]. 中國實用外科雜志, 2005; 25(6): 326328.
- 19. 萬偉, 吳小鵬, 唐艷. LC術(shù)聯(lián)合EST術(shù)治療膽囊及膽總管結(jié)石12例 [J]. 中國現(xiàn)代普通外科進展, 2005; 8(3): 156.
- 20. Arnold JC, Benz C, Martin WR, et al. Endoscopic papillary balloon dilation vs. sphincterotomy for removal of common bile duct stones: a prospective randomized pilot study [J]. Endoscopy, 2001; 33(7): 563567.
- 21. 李兆申. 積極開展急性膽源性胰腺炎的內(nèi)鏡治療 [J]. 胰腺病學, 2002; 2(2): 6567.
- 22. 張奇, 孫備. 梗阻型膽源性胰腺炎內(nèi)鏡治療時機的選擇 [J]. 中國普通外科雜志, 2008; 17(3): 203206.
- 23. 張圣道, 雷若慶. 國際胰腺病學會《急性胰腺炎外科處理指南》介紹及相關(guān)討論 [J]. 肝膽胰外科雜志, 2003; 15(2): 133134.
- 24. 于瀾, 姚欣敏, 胡先典, 等. 經(jīng)內(nèi)鏡治療急性膽源性胰腺炎30例報道 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(4): 396398.
- 25. Fan ST, Lai EC, Mok FP, et al. Early treatment of acute biliary pancreatitis by endoscopic papillotomy [J]. N Engl J Med, 1993; 328(4): 228232.
- 26. CarrLocke DL. Biliary pancreatitis [J]. Can J Gastroenterol, 2003; 17(3): 205208.
- 27. Ayub K, Imada R, Slavin J. Endoscopic retrograde cholangiopancreatography in gallstoneassociated acute pancreatitis [J]. Cochrane Database Syst Rev, 2004; (4): CD003630.
- 28. Schietroma M, Lattanzio R, Risetti A, et al. Treatment of acute biliary pancreatitis in the aged in the endolaparoscopic era [J]. Minerva Chir, 1999; 54(10): 677684.
- 29. Forssmann K, Singer MV.How to proceed? ERCP in acute pancreatitis? [J]. Praxis (Bern 1994), 1999; 88(12): 1317.
- 30. Jover R, Llach J, Bordas JM, et al. The usefulness of the timeliness of endoscopic sphincterotomy in severe acute pancreatitis of biliary origin [J]. Gastroenterol Hepatol, 1997; 20(7): 344346.
- 31. Farinon AM. Acute biliary pancreatitis [J]. Ann Ital Chir, 1998; 69(6): 751763.
- 32. 林爭, 譚國鉗, 雷朝暉. 早期內(nèi)鏡膽總管Oddi括約肌切開術(shù)治療急性膽源性胰腺炎 [J]. 中國內(nèi)鏡雜志, 2003; 9(8): 3537.