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目的探讨内镜治疗联合腹腔灌洗治疗重症急性胆源性胰腺炎的临床疗效。方法 2009年1月至2014年1月收治的重症急性胆源性胰腺炎患者90例,按数字随机分组法分为观察组及对照组,每组45例。对照组采用常规保守治疗;观察组在此基础上采用内镜逆行胰胆管造影(ERCP)及十二指肠乳头括约肌切开术(EST)联合腹腔灌洗治疗。腹腔灌洗治疗均于入院1~3 d进行,在B超引导下使用经皮肝穿刺胆道引流(PTCD)穿刺导管进行腹腔穿刺,在积液或积脓处留置引流管持续引流,2 d后用甲硝唑以及生理盐水进行腹腔灌洗。如有胰腺坏死感染、合并有脓肿予以手术治疗。动态观察血尿淀粉酶及血白细胞计数,比较两组的治疗效果。结果观察组45例患者行ERCP均成功,胆管显影率100%,所有患者均进行了EST,胆总管结石的清除率88.9%;腹腔引流放置PTCD管2~4根/例,放置时间为3~23 d。与对照组比较,观察组1个月内手术率、病死率均明显降低(P<0.05或P<0.01),治愈率略有提高(P>0.05),并发症发生率略有降低(P>0.05),腹痛缓解时间、血尿淀粉酶及白细胞恢复正常时间以及住院时间均明显缩短(P均<0.01)。结论内镜治疗联合腹腔灌洗对重症急性胆源性胰腺炎可以起到很好的治疗效果,恢复快,并发症少,病死率低,可以在一定程度上替代外科手术治疗。
Objective To investigate the clinical efficacy of endoscopic treatment combined with abdominal irrigation for the treatment of severe acute biliary pancreatitis. Methods Ninety patients with severe acute biliary pancreatitis admitted from January 2009 to January 2014 were randomly divided into observation group and control group according to the number randomization method, with 45 cases in each group. The control group received routine conservative treatment. The observation group was treated with endoscopic retrograde cholangiopancreatography (ERCP) and duodenal sphincterotomy (EST) combined with peritoneal lavage on this basis. Peritoneal lavage treatment were performed on admission 1 ~ 3 days, percutaneous puncture was performed with percutaneous transhepatic biliary drainage (PTCD) puncture catheter under B-ultrasound guidance, drainage was kept indwelling fluid or empyema, and after 2 days Peritoneal lavage with metronidazole and saline. If pancreatic necrosis, combined with abscess surgery. Dynamic observation of hematuria, amylase and white blood cell count, the treatment effect of two groups were compared. Results All 45 patients underwent echocardiography (ERCP) in the observation group and the rate of developing bile duct was 100%. All patients underwent EST and clearance rate of common bile duct stone was 88.9%. The peritoneal drainage placed 2 to 4 PTCD tubes per case, 23 d. Compared with the control group, the operation rate and mortality in the observation group were significantly decreased within 1 month (P <0.05 or P <0.01), the cure rate increased slightly (P> 0.05), and the complication rate decreased slightly (P> 0.05), the time of abdominal pain relief, the time of hematuria amylase and leukocyte recovery, and the length of hospital stay were significantly shorter (all P <0.01). Conclusion Endoscopic treatment combined with peritoneal lavage for severe acute biliary pancreatitis can play a very good therapeutic effect, rapid recovery, fewer complications, low mortality, can be a substitute for surgical treatment to some extent.