内镜治疗重症急性胆源性胰腺炎的临床研究
张成 安东均 陈阁
摘 要
目的：探讨内镜治疗重症急性胆源性胰腺炎（severe acute biliarypancreatitis，SABP）的价值。
方法：36例入院确诊为SABP后急诊手术。16例合并急性胆囊炎、胆囊结石，行内镜下鼻胆管引流术（endoscopic nasobiliary drainage，ENBD）；11例合并缩窄性乳头炎或胆总管结石，行内镜下乳头切开术（endoscopic sphincterotomy，EST）及ENBD；4例弓形刀及造影导管插入胆总管困难，选用针形刀行EST，并行ENBD；2例造影导管插入胆总管时，导丝反复进入胰管3次以上，用弓形刀切开十二指肠乳头括约肌后，寻找胆管开口，施行ENBD；3例行ENBD失败后改开腹手术。全组术后配合系统的内科治疗。
结果：ENBD成功施行33例，其中治愈29例，治愈率81%（29/36），死亡4例，病死率11%（4/36）。失败3例。术后胰周感染3例，无十二指肠乳头出血、十二指肠穿孔及胆管炎。全组住院时间15～75d，平均22d。26例成功者随访12～36个月，平均18个月，无胰腺炎症状复发。
结论：内镜治疗重症急性胆源性胰腺炎，配合系统的内科治疗，可明显减少患者的痛苦，缩短病程，提高治愈率。
关键词
内镜下鼻胆管引流术；重症急性胆源性胰腺炎
Clinical Study on Endoscopic Treatment of Severe Acute Biliary Pancreatitis
ZHANG Cheng，AN Dongjun，CHEN Ge.Department of HepatobiliaryPancreatic Surgery，Xianyang Central Hospital，Xianyang 712000，China
ABSTRACT
Objective:To explore the value of endoscopic treatment for severe acute biliarypancreatitis（SABP）.
Methods:36 patients underwent emergency surgery after being admitted to hospital and diagnosed as SABP.16 patients with acute cholecystitis and cholecystolithiasis underwent endoscopic nasobiliary drainage（ENBD）；11 patients complicated with constrictive papillitis or choledocholithiasis underwent endoscopic papillotomy（EST）and ENBD；4 cases had difficulty inserting arcuate knife and contrast catheter into common bile duct，needle knife was used for EST and ENBD.When the contrast catheter was inserted into the common bile duct in 2 cases，the guide wire repeatedly entered the pancreatic duct for more than 3 times.After the sphincter of duodenal papilla was incised with an arcuate knife，the bile duct opening was found and ENBD was performed.Three patients underwent laparotomy after ENBD failed.The whole group cooperated with systematic medical treatment after operation.
Results:ENBD was successfully implemented in 33 cases，of which 29 cases were cured，the cure rate was 81%（29/36），4 cases died，and the fatality rate was 11%（4/36）.There were 3 failures.Postoperative peripancreatic infection occurred in 3 cases，without duodenal papilla hemorrhage，duodenal perforation and cholangitis.The hospitali-zation time of the whole group ranged from 15 to 75 days，with an average of 22 days.The 26 successful cases were followed up for 12 to 36 months，with an average of 18 months.No recurrence of pancreatitis symptoms was found.
Conclusion:Endoscopic treatment of severe acute biliary pancreatitis，combined with systematic medical treatment，can significantly reduce the pain of patients，shorten the course of disease and improve the cure rate.
KEY WORDS
Endoscopicnasobiliary drainage；Severe acute biliary pancreatitis
重症急性胆源性胰腺炎（severeacutebiliarypancreatitis，SABP）具有病情凶险、发展迅速、病死率高等特点。我院2000年4月～2005年7月应用内镜技术治疗重症急性胆源性胰腺炎36例，病死率11%（4/36），报道如下。