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目的探讨治疗性 ERCP 在急性胆源性胰腺炎(acute biliary pancreatitis,ABP)治疗及减少复发中的临床价值。方法将 ABP 患者依据其治疗方式,分为内镜组行 ERCP 治疗和对照组行常规治疗,比较其腹痛缓解时间及血、尿淀粉酶降至正常时间及肝功能恢复时间和住院天数。随访所有 ABP 患者,比较两组患者复发率。结果 117例 ABP 患者中急性轻症胆源性胰腺炎患者99例(84.6%),急性重症胆源性胰腺炎患者18例(15.4%)。内镜组和对照组总例数分别为49例和68例。内镜组与对照组比较,急性轻症胆源性胰腺炎和急性重症胆源性胰腺炎的腹痛缓解时间、肝功能恢复时间、住院天数均明显缩短(P<0.05或 P<0.01)。血、尿淀粉酶恢复时间两组比较差异无统计学意义。内镜组无明显内镜治疗相关并发症发生。所有患者平均随访时间20个月(5～37个月);7例失访,随访率94.0%。内镜组的复发率0(0/46)明显低于对照组46.8%(29/62)(P<0.01)。结论与常规治疗比较,ERCP 治疗 ABP 是较好方法之一,不仅疗效好、恢复较快,而且安全,并能减少胆源性胰腺炎的复发。
Objective To investigate the clinical value of therapeutic ERCP in the treatment and recurrence of acute biliary pancreatitis (ABP). Methods According to the way of treatment, ABP patients were divided into endoscopic group and ERCP group. The control group received routine treatment. The pain relief time, blood amylase and urine amylase were reduced to normal time and liver function recovery time and hospitalization days. All ABP patients were followed up and the relapse rate was compared between the two groups. Results A total of 117 cases of ABP patients with acute mild biliary pancreatitis in 99 cases (84.6%), acute severe biliary pancreatitis in 18 patients (15.4%). The total number of endoscopic and control groups were 49 cases and 68 cases. Compared with the control group, the pain relief time, liver function recovery time and hospitalization days of acute severe biliary pancreatitis and acute severe biliary pancreatitis were significantly shortened (P <0.05 or P <0.01). Blood, urine amylase recovery time was no significant difference between the two groups. No significant endoscopic treatment of complications associated with endoscopic treatment. All patients were followed up for an average of 20 months (range, 5 to 37 months). Seven patients were lost and the follow-up rate was 94.0%. The recurrence rate 0 (0/46) in endoscopic group was significantly lower than that in control group (46.8%, 29/62) (P <0.01). Conclusion Compared with conventional treatment, ERCP treatment of ABP is one of the better methods, which not only has good curative effect, quick recovery, but also is safe and can reduce the recurrence of biliary pancreatitis.