非梗阻性急性胆源性胰腺炎早期内镜治疗的临床研究

发布时间：2018-04-29 04:26

本文选题：非梗阻性急性胆源性胰腺炎 + 内镜治疗　；参考：《广西医科大学》2014年硕士论文

【摘要】：目的：探讨非梗阻性急性胆源性胰腺炎早期行内镜治疗的临床疗效。方法：对2010年1月-2013年1月期间我院收住的95例非梗阻性急性胆源性胰腺炎(Acute biliary pancreatitis,ABP)患者，按2013年中国胰腺炎诊治指南标准分型，其中轻型急性胆源性胰腺炎（Mild acutebiliary pancreatitis，，MABP）40例，重型急性胆源性胰腺炎（Severe acutebiliary pancreatltls，SABP）55例。分别对轻型和重症非梗阻性ABP根据入院后采取不同的治疗方法分为实验组（早期内镜治疗组）和对照组（保守治疗组），其中MABP实验组16例，对照组24例，SABP实验组28例，对照组27例。实验组在入院48小时内行内镜治疗，对照组行禁食、胃肠减压、制酸、抑酶、抗感染、补液等保守治疗。分别比较非梗阻性MABP和SABP实验组和对照组治疗前后的腹痛缓解时间，白细胞、血尿淀粉酶、肝功能恢复正常时间，住院时间，住院费用，治愈率，并发症发生率和复发率等指标，结果采用SPSS16.0进行统计学处理。结果：分别比较MABP和SABP实验组与对照组的结果。（1）非梗阻性MABP实验组与对照组结果对比，腹痛缓解时间（2.43±0.65，3.60±1.25）天，白细胞下降至正常时间（2.28±0.61，2.87±1.08）天，血AMS恢复至正常时间（2.36±0.50，2.77±1.07）天，尿AMS恢复至正常时间（2.43±0.51，3.10±0.67）天，肝功能恢复正常时间（0.5±0.31，0.8±0.66）天，住院时间（6.86±1.66，7.32±2.17）天，住院费用（9538.27±2326.76，8351.86±2177.25）元，治愈率(93.75%,91.67%)，并发症发生率（6.25%，8.33%），复发率（6.25%，29.17%），实验组除了复发率低于对照组，结果有统计学意义（P 0.05），其他各项结果无显著性差异(PO．05)。（2）非梗阻性SABP实验组与对照组结果对比，腹痛缓解时间（3.50±0.688，10.21±3.77）天，白细胞下降至正常（3.40±0.60，9.50±3.77）天，血AMS恢复至正常时间（3.60±0.68，5.67±1.38）天，尿AMS恢复至正常时间（4.10±0.64，6.17±2.95）天，肝功能下降至正常时间（1.10±0.57，3.52±1.98）天，住院时间（10．25±2.51，17.81±3.93）天，住院费用（14672.25±3737.45，27780.67±6759.18）元，治愈率（96.43%，81.48%），并发症发生率（7.14%，25.93%），复发率（10.71%，33.33%）,各项观察指标实验组明显优于对照组，两组结果之间有统计学差异（P 0.05）。结论：（1）非梗阻性MABP早期内镜治疗无明显优势，建议采取保守治疗。（2）非梗阻性SABP发病48小时内行内镜治疗安全有效，具有创伤小，疗效好，恢复快，费用低，并发症少和复发率低，是一种理想的治疗方法，值得临床推广应用。
[Abstract]:Objective: to investigate the clinical effect of early endoscopic treatment for non-obstructive acute biliary pancreatitis. Methods: from January 2010 to January 2013, 95 patients with acute biliary pancreatitis (ABP) were classified according to the criteria for diagnosis and treatment of mild acute biliary pancreatitis, including 40 patients with mild acute biliary pancreatitis. Severe acute biliary pancreatitis (Severe acutebiliary pancreatl tlsd SABPP, 55 cases). Patients with mild or severe non-obstructive ABP were divided into experimental group (early endoscopic treatment group) and control group (conservative treatment group) according to different treatment methods after admission, including 16 cases of MABP experimental group and 24 cases of control group (28 cases of SABP-treated group). Control group (n = 27). The experimental group was treated by endoscopy within 48 hours of admission, while the control group was treated with conservative treatment such as fasting, gastrointestinal decompression, acid preparation, enzyme inhibition, anti-infection, fluid resuscitation and so on. The time of abdominal pain relief, leukocyte, blood and urine amylase, liver function recovery time, hospitalization time, hospitalization cost and cure rate were compared before and after treatment in non-obstructive MABP group and SABP group and control group, respectively. The incidence of complications and recurrence rate were analyzed by SPSS16.0. Results: the results of MABP and SABP groups were compared with those of the control group. The results of non-obstructive MABP group and control group showed that the abdominalgia relief time was 2.43 卤0.65U 3.60 卤1.25d, the leukopenia time was 2.28 卤0.61U 2.87 卤1.08d, the blood AMS returned to normal time 2.36 卤0.502.77 卤1.07d. The recovery time of AMS in urine was 2.43 卤0.51 卤3.10 卤0.67) days, the normal time of recovery of liver function was 0.5 卤0.31 / 0. 8 卤0.66) days, the hospitalization time was 6.86 卤1.66n 7.32 卤2.17) days, and the cost of hospitalization was 9538.27 卤2326.761 / 8351.86 卤2177.25) Yuan, the cure rate was 93.750.75 / 91.67m, the incidence of complications was 6.258.330.The recurrence rate was 6.250.29.170.In the experimental group, the recurrence rate was lower than that in the control group. The results were statistically significant (P 0.05), but there was no significant difference in other results (P < 0.05). 2) compared with the control group, the abdominalgia relief time was 3.50 卤0.688U 10.21 卤3.77 days, the leukocyte was decreased to 3.40 卤0.609.50 卤3.77 days, the blood AMS returned to normal time was 3.60 卤0.68 卤5.67 卤1.38 days, the urinary AMS returned to normal time was 4.10 卤0.646.17 卤2.95 days, the liver function decreased to normal time 1.10 卤0.57v 3.52 卤1.98 days. The hospitalization time was 10.25 卤2.51 卤17.81 卤3.93 days, the hospitalization expenses were 14672.25 卤3737.45 卤27780.67 卤6759.18 yuan, the cure rate was 96.43 ~ 81.48 meters, the incidence of complications was 7.1414 ~ 25.93% and the recurrence rate was 10.71 ~ 33.333.The experimental group was obviously better than the control group, and the difference between the two groups was significant (P 0.05). Conclusion: there is no obvious advantage in early endoscopic treatment of non-obstructive MABP. It is recommended to take conservative treatment. It is recommended that endoscopic treatment within 48 hours after onset of non-obstructive SABP is safe and effective, with small trauma, good curative effect, quick recovery and low cost. It is an ideal treatment method with less complications and low recurrence rate. It is worth popularizing and applying in clinic.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R657.51

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