CAJ | 학술논문

目的探讨急性胆源性胰腺炎合并持续性胆总管结石的预测指标和治疗选择.方法回顾分析广州医学院第三附属医院近10年内治疗134例急性胆源性胰腺炎的临床资料.结果 134例急性胆源性胰腺炎病例中,30例经胆道造影或胆总管探查确诊胆总管结石阳性.多因素分析显示,入院时B超下胆总管直径(common bile duct,CBD size)、碱性磷酸酶(ALP)、总胆红素(TB)与胆总管结石显著相关.应用ROC曲线获得诊断胆总管结石的最佳预测值为:CBD size≥10 mm;ALP ≥150 U/L;TB≥51.3μmol/L.结论 3项预测指标均为阳性时诊断胆总管持续性结石具有统计学意义,建议行ERCP/EST或术中胆总管探查.各项诊断指标均为阴性时,建议行保守治疗,住院期间行胆囊切除术.当仅含有1、2项预测指标阳性时,需根据病例具体情况作相应胆道评估或治疗.
목적 탐토급성담원성이선염합병지속성담총관결석적예측지표화치료선택.방법 회고분석엄주의학원제삼부속의원근10년내치료134례급성담원성이선염적림상자료.결과 134례급성담원성이선염병례중,30례경담도조영혹담총관탐사학진담총관결석양성.다인소분석현시,입원시B초하담총관직경(common bile duct,CBD size)、감성린산매(ALP)、총담홍소(TB)여담총관결석현저상관.응용ROC곡선획득진단담총관결석적최가예측치위:CBD size≥10 mm;ALP ≥150 U/L;TB≥51.3μmol/L.결론 3항예측지표균위양성시진단담총관지속성결석구유통계학의의,건의행ERCP/EST혹술중담총관탐사.각항진단지표균위음성시,건의행보수치료,주원기간행담낭절제술.당부함유1、2항예측지표양성시,수근거병례구체정황작상응담도평고혹치료.
Objective To investigate the treatment options of acute biliary pancreatitis.Methods A retrospective review was performed in 134 consecutive patients who presented to a single tertiary care institution from 2000 to 2010 with acute biliary pancreatitis.Results Of the 134 patients,30 had a persistent (commonbile duct,CBD)stone.Following multivariate analysis,at admission CBD size on ultrasound,alkaline phosphatase(ALP),total bilirubin(TB),significantly correlated with persistent CBD stone.Receiver operator curve analysis and linear regression were applied to obtain optimal and equitable predictive values,and variables combined.Optimal values were.,CBD≥10 mm;AP≥150 U/L;and TB≥51.3μmol/L.Presence of three variables had an associated odds ratio(OR)of29.5(P<0.001)for presence of persistent CBD stone.Zero variables conferred asignificantly decreased probability of CBD stone,OR 0.07(P<0.001).Conclusions Presence of three variables significantly correlated with persistent CBD stone.Biliary evaluation by endoscopic retrograde cholangiopancreatography(ERCP)is suggested.In the absence of any positive predictive variables,cholecystectomy may be sufficient.Decisions regarding patients with one to two be made vailables should occur on a case-to-case basis.