论文部分内容阅读
目的分析内镜胆管减压(EBD)治疗急性胰腺炎(AP)的疗效和临床应用价值。方法20年来分两个阶段共用EBD法治疗AP病人260例。1985～1994年为前瞻性随机对照研究阶段,观察对象为轻型AP(MAP)及早期重症急性胰腺炎(SAP),均为胆源性AP,共152例。治疗组78例行内镜治疗,方法是先行ENBD,若插管失败,再行EST后ENBD。对照组74例行常规内科保守治疗。1995～2005年为扩大临床应用阶段,观察对象为胆源性AP98例,非胆源性AP84例。治疗方法有所改进,行EST的比例增加。结果第一阶段治疗组AP治愈率为87.2%,重型化率为3.8%,与对照组(71.6%,14.9%)相比差异显著;病死率为1.3%,与对照组5.4%相比差异无显著性。第二阶段胆源性轻型AP操作成功率为97.1%,治愈率为92.9%,重型化率为2.9%。胆源性重型AP操作成功率为64.3%,治愈率为60.7%,病死率为5.6%。非胆源性轻型AP操作成功率为98.6%,治愈率为69.6%;非胆源性重型AP操作成功率为43.8%,病死率为17.2%。结论EBD对于胆源性AP病人能迅速阻断MAP向SAP进展,有效地降低了重型胰腺炎的发生率;同时应严格掌握EBD治疗AP的适应证和时机,不宜选择进展期SAP病人,早期治疗效果好。
Objective To analyze the efficacy and clinical value of endoscopic biliary decompression (EBD) in the treatment of acute pancreatitis (AP). Methods In the past 20 years, 260 cases of AP patients were treated with EBD method in two phases. From 1985 to 1994, a prospective randomized controlled study was conducted. The subjects were light AP (AP) and early severe acute pancreatitis (SAP). All of them were biliary AP, with a total of 152 cases. Treatment group of 78 patients underwent endoscopic treatment, the method is the first ENBD, if intubation fails, then ENBD after EST. Control group, 74 cases of conventional medical conservative treatment. From 1995 to 2005 to expand the clinical application stage, observed objects were biliary AP98 cases, non-biliary source AP84 cases. The treatment has been improved, the proportion of EST increased. Results In the first phase of treatment, the cure rate of AP was 87.2% and the rate of hyperplasia was 3.8%, which was significantly different from the control group (71.6%, 14.9%); the case fatality rate was 1.3%, which was significantly lower than that of the control group Significance. In the second stage, the successful rate of biliary-type light AP was 97.1%, the cure rate was 92.9% and the rate of heavy-type was 2.9%. The success rate of biliary heavy AP operation was 64.3%, the cure rate was 60.7% and the case fatality rate was 5.6%. Non-biliary source light AP operation success rate was 98.6%, the cure rate was 69.6%; non-biliary heavy AP operation success rate was 43.8%, the case fatality rate was 17.2%. Conclusions EBD can rapidly block the progression of MAP to SAP in patients with gallstone-like AP, and effectively reduce the incidence of severe pancreatitis. At the same time, the indications and timing of EB for AP should be strictly controlled. Therefore, it is not appropriate to choose advanced SAP patients and early treatment Good effect.