急性复发性胰腺炎病因、临床特征及诊疗的回顾性分析
发布时间：2018-09-06 19:09
【摘要】：目的:通过总结我院急性复发性胰腺炎(Acute recurrent pancreatitis,ARP)患者的病因、相关特征(性别、年龄、复发次数及时间间隔、相关实验室生化指标等)及诊疗方法的选择让临床工作者对ARP有更深刻的认识,从而指导临床早期干预,明确并去除病因,从而提高治愈率,降低胰腺炎患者的复发率、并发症和病死率,减轻患者的痛苦,改善预后。方法:收集2015年1月至2016年5月在皖南医学院附属弋矶山医院消化内科住院的急性胰腺炎(Acute pancreatitis,AP)患者的病例资料(共394例),其中有86例患者AP反复发作,归为复发组(Relapse Group,RG),其余归为首发组(Primary Group,PG),分析比较两组患者的可能致病因素和临床特征,以及对于ARP患者早期明确判别可能的致病因素及针对致病因素选择适当有效的治疗方法。结果:共收集我院AP患者394例,(1)一般资料性别比较:其中首发组有308例(78.2%),男性156例(50.6%),女性152例(49.4%);复发组有86例(21.8%),男女各有43例,两组性别差异χ2=0.011,P0.05,无统计学意义。(2)一般资料年龄比较:PG平均年龄55.955±16.166岁,RG平均年龄53.826±16.919岁,两组年龄差异t=1.069,P=0.2860.05,无统计学意义。(3)复发次数比较:复发一次有62例(72.1%),其中男性30例(48.4%),女性32例(51.6%),复发多次(≥2次)有24例(27.9%),其中男性13例(54.2%),女性11例(45.8%),复发次数与性别的差异χ2=0.2312,P0.05,无统计学意义。(4)复发时间间隔比较:复发时间间隔=6月有59人,占68.6%,其中男性25例(42.4%),女性34例(57.6%),复发间隔6月有27人,占31.4%,其中男性18人(66.7%),女性9例(33.3%),复发时间间隔性别差异χ2=4.37,P0.05,有统计学意义。(5)可能致病因素比较:PG中胆源性有208例(占67.5%),高脂血症性有35(占11.4%),酒精性有30例(占9.7%)其他因素有35例(占11.4%),RG中胆源性有50例(占58.1%),高脂血症性有19例(占22.1%),酒精性有8例(占9.3%),其他因素有9例(占10.5%),两组胰腺炎前三位致病因素均为胆源性(χ2=2.62,P0.05)、高脂血症性(χ2=6.54,P0.05)、酒精性(χ2=0.02,P0.05),其中两组致病因素为高脂血症性的差异有统计学意义,为胰腺炎复发高危因素。复发组中重症急性胰腺炎(Severe acute pancreatitis,SAP)有19例,其中胆源性13例,其他因素有6例,轻症AP有67例,其中胆源性有37例,非胆源性有30例,胆源性因素与胰腺炎轻重的比较χ2=1.06,P0.05,差异无统计学意义。(6)实验室指标比较:入院时首发组白细胞平均值为11.485±4.798(×109/L),复发组平均值为11.038±3.764(×109/L),t=0.884 p=0.3770.05无统计学意义;入院时血钙首发组平均值为2.069±0.258(mmol/L),复发组平均值为2.122±0.233(mmol/L),t=1.702 P=0.090.05,无统计学意义;入院时甘油三酯首发组平均值为1.448±1.426(mmol/L),复发组平均值为1.402±1.291(mmol/L),t=0.244 P=0.8080.05,无统计学意义。(7)诊断及治疗:急性复发性胰腺炎患者多由腹部B超、MRCP、超声内镜、ERCP(endoscopic retrograde cholangiopancreatography)等明确诊断病因,本研究中有3例患者第一次发作未查明原因,复发1次或多次再行ERCP检查诊断为胆总管下端小结石、胰腺分裂、Oddi括约肌功能障碍(Sphincter of Oddi dysfunction,SOD),1例因胆囊结石反复发作AP,行LC术后病理诊断胆囊癌;ARP的治疗方法有内科综合治疗、内镜下介入治疗及外科手术治疗等。结论:1.我院ARP患者首三位致病因素为胆源性、高脂血症性、酒精性,其中高脂血症性为AP复发高危因素;2.内镜下介入微创治疗(如ERCP术、EST术、胆胰管支架置入术等),在病因的诊断、早期有效的干预、预防复发等方面起着重大的作用,尤其是胆源性胰腺炎和特发性胰腺炎(Idiopathic pancreatitis,IP),值得临床推广应用;3.复发组中患者多于半年内复发,且女性患者多见。
[Abstract]:Objective: To summarize the etiology, related characteristics (sex, age, recurrence times and intervals, related laboratory biochemical indicators, etc.) of patients with acute recurrent pancreatitis (ARP) in our hospital and the choice of diagnosis and treatment methods so that clinical workers have a deeper understanding of ARP, so as to guide early clinical intervention, make clear and go. Methods: From January 2015 to May 2016, 394 patients with acute pancreatitis (AP) hospitalized in the Department of Gastroenterology, Yijishan Hospital, Southern Anhui Medical College, were collected. Eighty-six patients with recurrent AP were classified as Relapse Group (RG) and the rest as Primary Group (PG). The possible pathogenic factors and clinical characteristics of the two groups were analyzed and compared. The possible pathogenic factors were identified in early stage of ARP and appropriate and effective treatment methods were selected for the pathogenic factors. There were 394 AP patients in our hospital. (1) Gender comparison of general data: 308 (78.2%) in the first group, 156 (50.6%) in males and 152 (49.4%) in females; 86 (21.8%) in the recurrence group, 43 in males and 43 in females respectively. The difference between the two groups was 2 = 0.011, P 0.05, with no statistical significance. (2) Age comparison of general data: PG average age 55.955 [16.166], RG average age 53.826 [16.826]. 919 years old, the age difference between the two groups t = 1.069, P = 0.2860.05, there was no statistical significance. (3) Relapse times: 62 cases (72.1%) had one recurrence, including 30 males (48.4%), 32 females (51.6%) and 24 cases (27.9%) had multiple recurrences (> 2), including 13 males (54.2%) and 11 females (45.8%). The recurrence times and gender differences 2 = 0.2312, P 0.05, no statistical significance. Significance. (4) Comparison of recurrence interval: the recurrence interval was 59 (68.6%) in 6 months, 25 (42.4%) in males, 34 (57.6%) in females, 27 (31.4%) in 6 months, 18 (66.7%) in males and 9 (33.3%) in females. The difference of recurrence interval between sexes was 2 = 4.37, P 0.05, with statistical significance. There were 208 cases (67.5%), 35 cases (11.4%) with hyperlipidemia, 35 cases (9.7%) with alcoholism, 35 cases (11.4%) with other factors, 50 cases (58.1%) with gallstone in RG, 19 cases (22.1%) with hyperlipidemia, 8 cases (9.3%) with alcoholism, and 9 cases (10.5%) with other factors. The first three pathogenic factors of pancreatitis in both groups were gallstone (2=2.62, P There were 19 cases of severe acute pancreatitis (SAP) in the recurrence group, including 13 cases of biliary origin, 6 cases of other factors, 67 cases of mild AP. There were 37 cases of biliary origin and 30 cases of non-biliary origin. The comparison of biliary factors with the severity of pancreatitis_2 = 1.06, P 0.05 showed no significant difference. (6) Laboratory index comparison: the average white blood cells in the first group at admission was 11.485 [4.798] and that in the recurrence group was 11.038 [3.764] and t = 0.884 P = 0.3770.05. The mean of serum calcium was 2.069 (+ 0.258) in the first onset group, 2.122 (+ 0.233) in the recurrence group and 1.702 P = 0.090.05 in the T = 1.702 P = 0.090.05, with no statistical significance; the mean of serum calcium in the first onset group was 1.448 (+ 1.426 mmol / L) and that in the recurrence group was 1.402 (+ 1.291 mmol / L), t = 0.244 P = 0.8080.05, with no statistical significance. Most patients with recurrent pancreatitis were diagnosed by abdominal ultrasonography, MRCP, endoscopic ultrasonography, and ERCP (endoscopic retrograde cholangiopancreatography). In this study, 3 patients with first episode were not identified. Recurrence of one or more ERCP tests were diagnosed as common bile duct stones, pancreatic fission, Oddi sphincter dysfunction. (Sphincter of Oddi dysfunction, SOD), 1 case of recurrent AP due to gallstones, pathological diagnosis of gallbladder cancer after LC; ARP treatment methods include comprehensive medical treatment, endoscopic interventional therapy and surgical treatment. High risk factors for recurrence; 2. Endoscopic interventional minimally invasive treatment (such as ERCP, EST, biliopancreatic stent implantation, etc.) plays an important role in the etiological diagnosis, early and effective intervention, prevention of recurrence and other aspects, especially biliary pancreatitis and idiopathic pancreatitis (IP), worthy of clinical application; 3. Recurrent group suffered from the disease; Patients relapsed more than half a year, and female patients were more frequent.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576
本文编号：2227260
[Abstract]:Objective: To summarize the etiology, related characteristics (sex, age, recurrence times and intervals, related laboratory biochemical indicators, etc.) of patients with acute recurrent pancreatitis (ARP) in our hospital and the choice of diagnosis and treatment methods so that clinical workers have a deeper understanding of ARP, so as to guide early clinical intervention, make clear and go. Methods: From January 2015 to May 2016, 394 patients with acute pancreatitis (AP) hospitalized in the Department of Gastroenterology, Yijishan Hospital, Southern Anhui Medical College, were collected. Eighty-six patients with recurrent AP were classified as Relapse Group (RG) and the rest as Primary Group (PG). The possible pathogenic factors and clinical characteristics of the two groups were analyzed and compared. The possible pathogenic factors were identified in early stage of ARP and appropriate and effective treatment methods were selected for the pathogenic factors. There were 394 AP patients in our hospital. (1) Gender comparison of general data: 308 (78.2%) in the first group, 156 (50.6%) in males and 152 (49.4%) in females; 86 (21.8%) in the recurrence group, 43 in males and 43 in females respectively. The difference between the two groups was 2 = 0.011, P 0.05, with no statistical significance. (2) Age comparison of general data: PG average age 55.955 [16.166], RG average age 53.826 [16.826]. 919 years old, the age difference between the two groups t = 1.069, P = 0.2860.05, there was no statistical significance. (3) Relapse times: 62 cases (72.1%) had one recurrence, including 30 males (48.4%), 32 females (51.6%) and 24 cases (27.9%) had multiple recurrences (> 2), including 13 males (54.2%) and 11 females (45.8%). The recurrence times and gender differences 2 = 0.2312, P 0.05, no statistical significance. Significance. (4) Comparison of recurrence interval: the recurrence interval was 59 (68.6%) in 6 months, 25 (42.4%) in males, 34 (57.6%) in females, 27 (31.4%) in 6 months, 18 (66.7%) in males and 9 (33.3%) in females. The difference of recurrence interval between sexes was 2 = 4.37, P 0.05, with statistical significance. There were 208 cases (67.5%), 35 cases (11.4%) with hyperlipidemia, 35 cases (9.7%) with alcoholism, 35 cases (11.4%) with other factors, 50 cases (58.1%) with gallstone in RG, 19 cases (22.1%) with hyperlipidemia, 8 cases (9.3%) with alcoholism, and 9 cases (10.5%) with other factors. The first three pathogenic factors of pancreatitis in both groups were gallstone (2=2.62, P There were 19 cases of severe acute pancreatitis (SAP) in the recurrence group, including 13 cases of biliary origin, 6 cases of other factors, 67 cases of mild AP. There were 37 cases of biliary origin and 30 cases of non-biliary origin. The comparison of biliary factors with the severity of pancreatitis_2 = 1.06, P 0.05 showed no significant difference. (6) Laboratory index comparison: the average white blood cells in the first group at admission was 11.485 [4.798] and that in the recurrence group was 11.038 [3.764] and t = 0.884 P = 0.3770.05. The mean of serum calcium was 2.069 (+ 0.258) in the first onset group, 2.122 (+ 0.233) in the recurrence group and 1.702 P = 0.090.05 in the T = 1.702 P = 0.090.05, with no statistical significance; the mean of serum calcium in the first onset group was 1.448 (+ 1.426 mmol / L) and that in the recurrence group was 1.402 (+ 1.291 mmol / L), t = 0.244 P = 0.8080.05, with no statistical significance. Most patients with recurrent pancreatitis were diagnosed by abdominal ultrasonography, MRCP, endoscopic ultrasonography, and ERCP (endoscopic retrograde cholangiopancreatography). In this study, 3 patients with first episode were not identified. Recurrence of one or more ERCP tests were diagnosed as common bile duct stones, pancreatic fission, Oddi sphincter dysfunction. (Sphincter of Oddi dysfunction, SOD), 1 case of recurrent AP due to gallstones, pathological diagnosis of gallbladder cancer after LC; ARP treatment methods include comprehensive medical treatment, endoscopic interventional therapy and surgical treatment. High risk factors for recurrence; 2. Endoscopic interventional minimally invasive treatment (such as ERCP, EST, biliopancreatic stent implantation, etc.) plays an important role in the etiological diagnosis, early and effective intervention, prevention of recurrence and other aspects, especially biliary pancreatitis and idiopathic pancreatitis (IP), worthy of clinical application; 3. Recurrent group suffered from the disease; Patients relapsed more than half a year, and female patients were more frequent.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576
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