急性胆源性胰腺炎内镜与传统治疗效果与安全性的随机对照观察.docVIP

急性胆源性胰腺炎内镜与传统治疗效果与安全性的随机对照观察 　　作者：曲永清 作者单位：广东医学院第三附属医院消化内科，广东茂名 525011 　　【摘要】 目的 比较内镜下治疗与传统治疗急性胆源性胰腺炎(ABP)的效果和安全性。方法 68例随机分为内镜组和传统组各34例(重症患者分别有9、8例)，所有患者入院后即给予内科综合治疗，内镜组患者入院24 h内行十二指肠乳头括约肌切开术，传统组患者待病情稳定后择期手术。结果 内镜组：34例ABP的血常规、淀粉酶和血生化于1、2周内基本恢复;25例轻症者经内镜治疗后2～5d体温恢复正常;9例重症者3～8d腹部体征好转。传统组：34例中有6例行急症手术。内镜组的重症患者并发症发生率为11.1%(1/9);而传统组为50%(4/8)，其数值是高于内镜组，但差异无统计学意义(P0.05)。内镜组住院时间为(16.5±4.0)d，低于传统组的(54.0±37.0)d，差异有统计学意义(P0.05)。结论 内镜下行微创治疗ABP的住院时间短且安全性好。 　　【关键词】 内镜手术;急性胆源性胰腺炎;十二指肠乳头括约肌切开术 　　Comparison between endoscopic surgery and conventional treatment in acute biliary pancreatitis 　　QU Yongqing 　　Department of Gastroenterology, the 3rd Affiliated Hospital of Guangdong Medical College, Maoming 525011, China 　　Abstract: Objective To observe the efficacy and safety of endoscopic surgery and conventional treatment in acute biliary pancreatitis (ABP).Methods Sixtyeight patients were randomly allocated to two groups, and then received endoscopic sphincterotomy (endoscopic group) during 24 h or conventional treatment (conservative group).Results Blood count, serum amylase and biochemical indexes recovered generally during 12 weeks in endoscopic group; of them, 25 mild cases had normal temperature during 25 days, and 9 severe ones showed the improvement of abdominal signs during 38 days. Six cases underwent emergency operation in conservative group.There was no statistical difference in the complication of severe patients between both groups (P0.05). The length of stay in conservative group was superior to that in endoscopic group (P0.05).Conclusion Endoscopic sphincterotomy is safe and effective for ABP. 　　Key words: endoscopic surgery; acute biliary pancreatitis; endoscopic sphincterotomy 　　急性胆源性胰腺炎(acute biliary pancreatitis，ABP)是一种常见的外科急腹症，占急性胰腺炎总发病率的50%以上，该病起病急、发展快、病死率高[1]。传统疗法是内科综合冶疗和/或外科手术治疗，但疗效欠佳。与外科手术相比，内镜治疗具有简便易行，痛苦小，并发症少，住院时间短，成本低等优势[2]。随着逆行胰胆管造影(ERCP)技术的不断进步，内镜治疗急性胆源性胰腺炎已达成了共识[3]。目前与此有关的随机对照研究报道不多。本文是1996年以来对我院收治的ABP患者68例随机用内镜治疗和传统