王健 1 , 杜波 1 , 胡兵 2 , 謝志華 3 , 但杰 1 , 鐘顯飛 3
  • 1.樂(lè)山市人民醫(yī)院外一科(四川樂(lè)山 614000);;
  • 2.四川大學(xué)華西醫(yī)院內(nèi)鏡中心(成都 610041);;
  • 3.樂(lè)山市人民醫(yī)院內(nèi)一科(四川樂(lè)山 614000);

目的 評(píng)價(jià)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(shí)間、住院時(shí)間、血淀粉酶恢復(fù)時(shí)間、血白細(xì)胞恢復(fù)時(shí)間及肝功能恢復(fù)時(shí)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(shí)間、住院時(shí)間、血淀粉酶恢復(fù)時(shí)間、血白細(xì)胞恢復(fù)時(shí)間和肝功能恢復(fù)時(shí)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(yán)重并發(fā)癥。未見(jiàn)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(jìn)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(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(9): 970-973. doi: 復(fù)制

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國(guó)普外基礎(chǔ)與臨床雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

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): 421429.
2. Uomo G, Slavin J. Endoscopic sphincterotomy for acute pancreatitis: arguments in favour [J]. Ital J Gastroenterol Hepatol, 1998; 30(5): 557561.
3. 中華醫(yī)學(xué)會(huì)消化病學(xué)分會(huì)胰腺疾病學(xué)組. 中國(guó)急性胰腺炎診治指南(草案) [J]. 中華內(nèi)科雜志, 2004; 43(3): 236238.
4. Cohen S, Bacon BR, Berlin JA, et al. National Institutes of Health StateoftheScience Conference Statement: ERCP for diagnosis and therapy, January 1416, 2002 [J]. Gastrointest Endosc, 2002; 56(6): 803809.
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): Ⅲ1Ⅲ19.
6. 中華醫(yī)學(xué)會(huì)消化病學(xué)分會(huì)胰腺疾病學(xué)組. 中國(guó)急性胰腺炎診治指南(草案) [J]. 中華消化雜志, 2004; 24(3): 190192.
7. 張志功, 朱化剛, 孟翔凌, 等. APACHEⅡ、RANSON 評(píng)分在重癥急性胰腺炎中的應(yīng)用價(jià)值 [J]. 肝膽外科雜志, 2005; 13(1): 3235.
8. 孫明. 內(nèi)科治療學(xué) [M]. 第12版. 北京: 人民衛(wèi)生出版社, 2006: 352354.
9. 鄭芝田. 胃腸病學(xué) [M]. 北京： 人民衛(wèi)生出版社, 2000: 13781379.
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): 235239.
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): 117122.
12. Kaiser AM, Saluja AK, Steer ML. Repetitive shortterm obstructions of the common bilepancreatic duct induce severe acute pancreatitis in the opossum [J]. Dig Dis Sci, 1999; 44(8): 16531661.
13. 張肇達(dá), 田伯樂(lè). 急性膽源性胰腺炎 [J]. 中華肝膽外科雜志, 2002; 8(2): 93.
14. 李學(xué)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(xué)院學(xué)報(bào), 2008; 28(4): 520521.
15. Pezzilli R, Billi P, MorselliLabate AM, et al. Anesthesiological risk and endoscopic sphincterotomy in acute biliary pancreatitis [J]. Pancreas, 2003; 26(4): 334338.
16. 袁耀宗. 胰腺病學(xué)新進(jìn)展與新技術(shù) [M]. 上海： 上?？茖W(xué)技術(shù)文獻(xiàn)出版社， 2001: 324325.
17. Schietroma M, Carlei F, Lezoche E, et al. Acute biliary pancreatitis: staging and management [J]. Hepatogastroenterology, 2001; 48(40): 988993.
18. 李兆申. 膽胰疾病的內(nèi)鏡治療 [J]. 中國(guó)實(shí)用外科雜志, 2005; 25(6): 326328.
19. 萬(wàn)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(guó)現(xiàn)代普通外科進(jìn)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): 563567.
21. 李兆申. 積極開(kāi)展急性膽源性胰腺炎的內(nèi)鏡治療 [J]. 胰腺病學(xué), 2002; 2(2): 6567.
22. 張奇, 孫備. 梗阻型膽源性胰腺炎內(nèi)鏡治療時(shí)機(jī)的選擇 [J]. 中國(guó)普通外科雜志, 2008; 17(3): 203206.
23. 張圣道, 雷若慶. 國(guó)際胰腺病學(xué)會(huì)《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): 133134.
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(bào)道 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2007; 14(4): 396398.
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): 228232.
26. CarrLocke DL. Biliary pancreatitis [J]. Can J Gastroenterol, 2003; 17(3): 205208.
27. Ayub K, Imada R, Slavin J. Endoscopic retrograde cholangiopancreatography in gallstoneassociated 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): 677684.
29. Forssmann K, Singer MV.How to proceed? ERCP in acute pancreatitis? [J]. Praxis (Bern 1994), 1999; 88(12): 1317.
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): 344346.
31. Farinon AM. Acute biliary pancreatitis [J]. Ann Ital Chir, 1998; 69(6): 751763.
32. 林爭(zhēng), 譚國(guó)鉗, 雷朝暉. 早期內(nèi)鏡膽總管Oddi括約肌切開(kāi)術(shù)治療急性膽源性胰腺炎 [J]. 中國(guó)內(nèi)鏡雜志, 2003; 9(8): 3537.
  1. 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): 421429.
  2. 2. Uomo G, Slavin J. Endoscopic sphincterotomy for acute pancreatitis: arguments in favour [J]. Ital J Gastroenterol Hepatol, 1998; 30(5): 557561.
  3. 3. 中華醫(yī)學(xué)會(huì)消化病學(xué)分會(huì)胰腺疾病學(xué)組. 中國(guó)急性胰腺炎診治指南(草案) [J]. 中華內(nèi)科雜志, 2004; 43(3): 236238.
  4. 4. Cohen S, Bacon BR, Berlin JA, et al. National Institutes of Health StateoftheScience Conference Statement: ERCP for diagnosis and therapy, January 1416, 2002 [J]. Gastrointest Endosc, 2002; 56(6): 803809.
  5. 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): Ⅲ1Ⅲ19.
  6. 6. 中華醫(yī)學(xué)會(huì)消化病學(xué)分會(huì)胰腺疾病學(xué)組. 中國(guó)急性胰腺炎診治指南(草案) [J]. 中華消化雜志, 2004; 24(3): 190192.
  7. 7. 張志功, 朱化剛, 孟翔凌, 等. APACHEⅡ、RANSON 評(píng)分在重癥急性胰腺炎中的應(yīng)用價(jià)值 [J]. 肝膽外科雜志, 2005; 13(1): 3235.
  8. 8. 孫明. 內(nèi)科治療學(xué) [M]. 第12版. 北京: 人民衛(wèi)生出版社, 2006: 352354.
  9. 9. 鄭芝田. 胃腸病學(xué) [M]. 北京： 人民衛(wèi)生出版社, 2000: 13781379.
  10. 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): 235239.
  11. 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): 117122.
  12. 12. Kaiser AM, Saluja AK, Steer ML. Repetitive shortterm obstructions of the common bilepancreatic duct induce severe acute pancreatitis in the opossum [J]. Dig Dis Sci, 1999; 44(8): 16531661.
  13. 13. 張肇達(dá), 田伯樂(lè). 急性膽源性胰腺炎 [J]. 中華肝膽外科雜志, 2002; 8(2): 93.
  14. 14. 李學(xué)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(xué)院學(xué)報(bào), 2008; 28(4): 520521.
  15. 15. Pezzilli R, Billi P, MorselliLabate AM, et al. Anesthesiological risk and endoscopic sphincterotomy in acute biliary pancreatitis [J]. Pancreas, 2003; 26(4): 334338.
  16. 16. 袁耀宗. 胰腺病學(xué)新進(jìn)展與新技術(shù) [M]. 上海： 上?？茖W(xué)技術(shù)文獻(xiàn)出版社， 2001: 324325.
  17. 17. Schietroma M, Carlei F, Lezoche E, et al. Acute biliary pancreatitis: staging and management [J]. Hepatogastroenterology, 2001; 48(40): 988993.
  18. 18. 李兆申. 膽胰疾病的內(nèi)鏡治療 [J]. 中國(guó)實(shí)用外科雜志, 2005; 25(6): 326328.
  19. 19. 萬(wàn)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(guó)現(xiàn)代普通外科進(jìn)展, 2005; 8(3): 156.
  20. 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): 563567.
  21. 21. 李兆申. 積極開(kāi)展急性膽源性胰腺炎的內(nèi)鏡治療 [J]. 胰腺病學(xué), 2002; 2(2): 6567.
  22. 22. 張奇, 孫備. 梗阻型膽源性胰腺炎內(nèi)鏡治療時(shí)機(jī)的選擇 [J]. 中國(guó)普通外科雜志, 2008; 17(3): 203206.
  23. 23. 張圣道, 雷若慶. 國(guó)際胰腺病學(xué)會(huì)《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): 133134.
  24. 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(bào)道 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2007; 14(4): 396398.
  25. 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): 228232.
  26. 26. CarrLocke DL. Biliary pancreatitis [J]. Can J Gastroenterol, 2003; 17(3): 205208.
  27. 27. Ayub K, Imada R, Slavin J. Endoscopic retrograde cholangiopancreatography in gallstoneassociated acute pancreatitis [J]. Cochrane Database Syst Rev, 2004; (4): CD003630.
  28. 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): 677684.
  29. 29. Forssmann K, Singer MV.How to proceed? ERCP in acute pancreatitis? [J]. Praxis (Bern 1994), 1999; 88(12): 1317.
  30. 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): 344346.
  31. 31. Farinon AM. Acute biliary pancreatitis [J]. Ann Ital Chir, 1998; 69(6): 751763.
  32. 32. 林爭(zhēng), 譚國(guó)鉗, 雷朝暉. 早期內(nèi)鏡膽總管Oddi括約肌切開(kāi)術(shù)治療急性膽源性胰腺炎 [J]. 中國(guó)內(nèi)鏡雜志, 2003; 9(8): 3537.