急性胆源性胰腺炎不同治疗方法的疗效分析
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赵振林 E-mail:zhlzhaosxmu@yahoo.com.cn

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R 657.5

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Analysis of therapeutic effect of different therapies for acute biliary pancreatitis
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    摘要:

    目的:探讨治疗急性胆源性胰腺炎(acute biliary pancretitis,ABP)的优化方案。
    方法:回顾性分析5年余收治的159例ABP患者的临床资料,根据疾病严重程度及有无胆道梗阻分为轻症非梗阻型(68例)、轻症梗阻型(43例)、重症非梗阻型(27例)、重症梗阻型(21例)。所有患者入院后先给予非手术治疗。对于伴有胆道梗阻的64例,根据解除梗阻的不同术式,分为内镜治疗组和开腹手术组,对比使用不同治疗方案的各组患者腹痛缓解时间、血清淀粉酶恢复时间、住院时间、治愈率、并发症发生率、病死率等指标。
    结果:不伴梗阻的95例患者均经非手术治疗治愈,且轻症组与重症组各指标比较,差异无统计学意义(P>0.05);伴有梗阻的64例中,入院后24 h内均行手术治疗。开腹手术组(26例)各指标与内镜治疗组(38例)比较,治疗效果差异有统计学意义,前者差于后者(P<0.05)。
    结论:胆源性胰腺炎应分型而治。非梗阻型ABP(轻型和重症)早期非手术治疗效果好;梗阻型ABP在非手术治疗的基础上早期解除胆道梗阻,通畅引流是治疗关键。内镜途径解除胆道梗阻与开腹手术比较,具有创伤小,安全性高,疗效更满意,是治疗梗阻型ABP的首选途径。

    Abstract:

    Objective:To explore the optimal therapeutic strategy for acute biliary pancreatitis (ABP).
    Methods:The clinical data of 159 patients with acute biliary pancreatitis treated in our hospital over a period of five years were retrospectively analyzed. The cases were divided into four types according to severity of disease and bile duct obstruction: Mild cases without bile duct obstruction (n=68); mild cases with bile duct obstruction (n=43); severe cases without bile duct obstruction (n=27); and severe cases with bile duct obstruction  (n=21). All cases received conservative treatment soon after admission. There were 64 cases with bile duct obstruction who underwent therapeutic endoscopy or open surgery to relieve bile duct obstruction.The time to relief of abdominal pain, the time of serum amylase returned to normal level,days of hospital stay,recovery rate,incidence of complications and fatality rate in the four groups with different therapeutic protocol were analyzed and compared.
    Results:The clinical manifeslations of 95 cases without bile duct obstruction were improved after receiving conservative treatment, and there was no significant difference of the tested  indexes between the mild group and severe group (P>0.05). All of the 64 cases with bile duct obstruction undergoing emergency operation, there was significant improvement of monitored indexes in the endoscopic therapy group (38 cases) in comparison with the open surgery group (26 cases) (P<0.05).
    Conclusions:The treatment of ABP should be selected according to the type of ABP. The non-operation protocol is effective for mild cases without bile duct obstruction; for the cases with bile duct obstruction, conservative treatment should be followed by either endoscopic biliary drainage or open surgery, and the endoscopic drainage should be preferred because of its mini-invasive advantage.

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秦静| 赵振林.急性胆源性胰腺炎不同治疗方法的疗效分析[J].中国普通外科杂志,2011,20(3):249-252.

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  • 收稿日期:2010-11-06
  • 最后修改日期:2011-02-17
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  • 在线发布日期: 2011-03-15
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