中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2010年
20期
14-16
,共3页
胰腺炎%胆汁淤积%手术后并发症%治疗
胰腺炎%膽汁淤積%手術後併髮癥%治療
이선염%담즙어적%수술후병발증%치료
Pancreatitis%Cholestasis%Postoperative complications%Therapy
目的 探讨梗阻型胆源性胰腺炎内镜治疗的时机与疗效.方法 回顾性分析160例梗阻型胆源性胰腺炎患者内镜治疗的临床资料.根据发病后内镜治疗时间分为两组:急诊组78例在发病<48 h行急诊内镜治疗;延期组82例在早期非手术治疗基础上于发病≥48 h行延期内镜治疗.结果 两组内镜治疗总成功率为96.2%(154/160).急诊组腹痛缓解时间[(4.98±1.75)d]、实验室指标恢复正常时间[(10.08±5.22)d]以及住院时间[(12.24±7.20)d]均显著低于延期组[分别为(5.54±2.53)、(12.93±6.60)、(16.38±6.94)d](P<0.05或<0.01).重症梗阻型胆源性胰腺炎急诊组术后总并发症发生率(9.6%,5/52)显著低于延期组(23.6%,13/55)(P<0.05),两组病死率比较差异无统计学意义(P>0.05).结论 重症梗阻型胆源性胰腺炎应在发病48 h内行急诊内镜治疗;轻症患者如早期非手术治疗无效或出现急性胆道感染症状,亦应争取及时行急诊内镜治疗.
目的 探討梗阻型膽源性胰腺炎內鏡治療的時機與療效.方法 迴顧性分析160例梗阻型膽源性胰腺炎患者內鏡治療的臨床資料.根據髮病後內鏡治療時間分為兩組:急診組78例在髮病<48 h行急診內鏡治療;延期組82例在早期非手術治療基礎上于髮病≥48 h行延期內鏡治療.結果 兩組內鏡治療總成功率為96.2%(154/160).急診組腹痛緩解時間[(4.98±1.75)d]、實驗室指標恢複正常時間[(10.08±5.22)d]以及住院時間[(12.24±7.20)d]均顯著低于延期組[分彆為(5.54±2.53)、(12.93±6.60)、(16.38±6.94)d](P<0.05或<0.01).重癥梗阻型膽源性胰腺炎急診組術後總併髮癥髮生率(9.6%,5/52)顯著低于延期組(23.6%,13/55)(P<0.05),兩組病死率比較差異無統計學意義(P>0.05).結論 重癥梗阻型膽源性胰腺炎應在髮病48 h內行急診內鏡治療;輕癥患者如早期非手術治療無效或齣現急性膽道感染癥狀,亦應爭取及時行急診內鏡治療.
목적 탐토경조형담원성이선염내경치료적시궤여료효.방법 회고성분석160례경조형담원성이선염환자내경치료적림상자료.근거발병후내경치료시간분위량조:급진조78례재발병<48 h행급진내경치료;연기조82례재조기비수술치료기출상우발병≥48 h행연기내경치료.결과 량조내경치료총성공솔위96.2%(154/160).급진조복통완해시간[(4.98±1.75)d]、실험실지표회복정상시간[(10.08±5.22)d]이급주원시간[(12.24±7.20)d]균현저저우연기조[분별위(5.54±2.53)、(12.93±6.60)、(16.38±6.94)d](P<0.05혹<0.01).중증경조형담원성이선염급진조술후총병발증발생솔(9.6%,5/52)현저저우연기조(23.6%,13/55)(P<0.05),량조병사솔비교차이무통계학의의(P>0.05).결론 중증경조형담원성이선염응재발병48 h내행급진내경치료;경증환자여조기비수술치료무효혹출현급성담도감염증상,역응쟁취급시행급진내경치료.
Objective To investigate the timing of endoscopic therapy of obstructive acute biliary pancreatitis. Methods One hundred and sixty cases of obstructive acute biliary pancreatitis treated by endoscopy were analyzed. The patients were divided into two groups:78 cases received emergency endoscopic therapy (EE group) within 48 hours from onset of symptoms,including endoscopic retrograde cholangiopan-creatography and endoscopic sphincterotomy,with or without stone extraction and endoscopic nasobiliary drainage;82 cases received delay endoscopic therapy (DE group) after initial 48 hours of conservative management Results The total success rate of therapeutic endoscopy was 96.2 % (154/160). In EE group, the time for disappearance of abdominal pain [(4.98±1.75)d],the time for laboratory recovery [(10.08± 5.22) d],and the length of hospitalization [(12.24 ± 7.20) d] were significantly shorter than those in DE group [(5.54±2.53),(12.93 ±6.60),(16.38 ±6.94) d](P<0.05 or <0.01). In cases with severe acute biliary pancreatitis,the morbidity in the EE group (9.6% ,5/52) was significantly lower than DE group (23.6%,13/55) (P<0.05),but the difference in mortality rate between the two groups was not significant (P>0.05). Conclusions In severe acute biliary pancreatitis patients with biliary tract obstruction, emergency endoscopic therapy should be performed within 48 hours from the onset of symptoms. Patients with mild acute biliary pancreatitis should also undergo prompt endoscopic therapy after ineffective conservative management or appearance of symptoms of acute biliary tract infection.
