急诊内镜在急性胆源性胰腺炎早期治疗中的应用.docVIP

急诊内镜在急性胆源性胰腺炎早期治疗中的应用 上海医学2003年第26卷第7期?481? ? 论着? 急诊内镜在急性胆源性胰腺炎早期治疗中的应用 陈胜吴卫泽王建承张卓韩天权张圣道 【摘要】目的探讨急诊内镜在急性胆源性胰腺炎早期治疗中的应用价值.方法自1999年1月～2002 年1月共收治急性胆源性胰腺炎或临床怀疑为胆源性胰腺炎患者184例,其中行急诊内镜治疗86例,行保守或 外科手术治疗98例.内镜组多在发病后12h～3d常规急诊行内镜逆行性胰胆管造影术(ERcP),鼻胆管引流 术,内镜下乳头括约肌切开术(EsT)和(或)网篮取石术.结果内镜操作总成功率为94.18%,未发生与内镜操 作有关的严重并发症.其中43例同时行EST及取石术,33例因Oddi括约肌狭窄而行EST,所有患者均放置鼻 胆管引流.内镜组中39例术前怀疑为胆源性胰腺炎,均由内镜证实,其中25例为胆管小结石或胆泥嵌顿于壶 腹部.与对照组相比,内镜组的腹痛缓解时间,胰腺炎相关局部和全身并发症的发生率,病死率,住院时间均明 显低于对照组(Plt;0.01),但两组间血胰淀粉酶变化的差异无显着性.结论急诊内镜治疗急性胰腺炎具有微 创,安全有效,操作时间短,快速解除胆道急性梗阻及防止胆汁胰管反流的优点,可使急性胆源性胰腺炎和临床 怀疑为胆源性胰腺炎的患者得到及时正确的诊治,以阻止病情进一步向重型发展. 【关键词】急性胆源性胰腺炎;内镜逆行胰胆管造新术;早期治疗;内镜括约肌切开术 phyandendoscopicsphincterotomyforacutebiliarypancre- atitisCHENSheng,WUWeize,WANGJiancheng,eta1.DepartmentofGeneralSurgery,RuijinHospi— tal,ShanghaiInstituteofDigestiveSurgery,ShanghaiSecondMedicalUniversity,Shanghai200025,China). 【Abstract】ObjectiveToinvestigatetheeffectivenessoftheemergencyendoscopicretrogradecholangiopan— creatographyandendoscopicsphincterotomyintreatmentofacutebiliarypancreatitis.Methods86casesadmittedfrom January1999tOJanuary2002undergoneemergencyendoscopicprocedureswereretrospectivelyanalyzed.Endoscopic retrogradecholangiopancreatography(ERCP)andendoscopicnaso-biliarydrainage(ENBD)wereperformedinallcases includingendoscopicsphincterotomy(EST)for76cases.Theresultsanddurationofhospitalizationwererecorded.Re- suitsSuccessfulratesofendoscopicmanagementwereachievedin94.18%.Therewerenoseverecomplicationsnor mortality;amongwhich43case~hadconcomitentESTandstoneextraction,33hadsphincteromyforOddis’sphinc— tericstenosis,39caseswithsuspectedacutebiliarypancreatitisofwhich25casesofbiliarymicrolithiasiswereverified byendoscopy.Themorbidityandmortalityofpancreatitisintheendoscopygroupweresignificantlylowerthanthoseof thecontrolgroup,thedurationofsymptomsandhospiallizationweresignificantlyshortercomparedtOthelatter.How— everandthefurthermoredifferenceinthechangesofserumamylaseWasnotsignificantbetweenthetwogroups.Con- clusionEmergencyendoscopy