目的 观察内镜治疗急性胆源性胰腺炎（ABP）的疗效及其并发症。方法 30例ABP患者在抗炎、抑酶等综合治疗基础上，经内镜（1～3 d 内）逆行胰胆管造影（ERCP）及经内镜十二指肠乳头括约肌切开（EST）或鼻胆管引流（ENBD）等治疗。结果 内镜治疗后22 例（73.3%）轻症急性胆源性胰腺炎（MABP）患者3～5 d 体温恢复正常； 8例（26.7%） 重症急性胆源性胰腺炎（SABP）患者3～8 d 腹部体征好转，血常规、淀粉酶及血生化1~2周内基本恢复，平均住院18.7 d，3例死亡（10.0%）。内镜治疗过程中5例出现十二指肠乳头括约肌切口少量出血，经简单治疗止血，未再出现其他并发症。与同期开腹手术治疗相比较，症状体征缓解、血常规、淀粉酶、血生化恢复正常及住院的时间更短，死亡率无明显差异。结论 ABP早期ERCP 及内镜治疗安全有效。
ObjectiveTo evaluate the therapic efficacy for severe acute pancreatitis (SAP) during different periods. MethodsAccording to internalized standard, 234 patients with SAP admitted to this hospital from January 1986 to October 2009 were included, which were divided into two stages based on the time of admitting to this hospital. The first stage named prior operation group was from January 1986 to August 1998 (n=117), the second stage named individual treatment group was from September 1998 to October 2009 (n=117). There was comparability in demography and clinic between two groups. The prior operation group primarily underwent laparotomy and medication, and the individual treatment group underwent multiple combined therapies. These indexes were compared between two groups: hospital stay, cure rate, and mortality; the incidences of pancreatic pseudocyst, pancreatic and peripancreatic abscess, pancreatic encephalopathy, cardiac insufficiency, acute renal failure (ARF), acute respiratory distress syndrome (ARDS), and shock. The efficacies for early treatment, ascites, biliary pancreatitis, and pancreatic and peripancreatic complications were compared two groups by stratified analysis. ResultsCompared with the prior operation group, the hospital stay was shorter (Plt;0.05), cure rate was higher (Plt;0.001), and mortality was lower in the individual treatment group (Plt;0.001). During the treatments, the incidences of pancreatic pseudocyst, pancreatic and peripancreatic abscess, pancreatic encephalopathy, cardiac insufficiency, ARF, ARDS, and shock in the individual treatment group were lower than those in the prior operation group (Plt;0.05). According to the stratified analysis, the efficacies for early treatment, ascites, biliary pancreatitis, and pancreatic and peripancreatic complications in the individual treatment group were better than those in the prior operation group (Plt;0.001). ConclusionIn recent years, the change of therapeutic mode significantly improves the treatment efficacy for SAP.