摘要
目的探索内镜下胰管括约肌切开（EPS）联合胰管支架置入对胆道微结石性急性复发性胰腺炎的治疗效果。方法回顾性分析2005年4月至2016年11月间诊断为急性复发性胰腺炎且病因是胆道微结石的71例患者资料，根据不同的内镜治疗方式非随机分为两组，34例行内镜下胰管括约肌切开联合胰管支架置入术（EPS组），37例行内镜下乳头括约肌切开（EST）联合胆道清理术（EST组），比较两组的复发率和术后并发症，分析影响术后复发的因素。结果EPS组随访2—108个月，中位数21．5个月；EST组随访5～120个月，中位数39个月。术后1年内7例急性胰腺炎复发，EPS组2例（5．9％），EST组5例（13．5％），差异无统计学意义（χ^2=0．461，P=0．497）。术后5年内13例急性胰腺炎复发，EPS组4例，EST组9例，COX回归模型分析显示不同的内镜治疗方式（RR=6．808，95％CI：1．389—33．356，P=0．018）和2型糖尿病（RR=0．134，95％CI：0．029—0．608，P=0．009）是影响术后5年内胰腺炎复发的因素。ERCP术后胰腺炎EPS组发生7例（20．6％），EST组发生4例（10．8％），差异无统计学意义（χ^2=1．294，P=0．255）。胆道并发症EPS组发生4例（11．8％），EST组发生9例（24．3％），差异无统计学意义（χ^2=1．869，P=0．172）。结论EPS联合胰管支架置入术治疗胆道微结石导致的急性复发性胰腺炎是有效的。2型糖尿病也会影响急性胰腺炎的复发。
Objective To investigate the clinical efficiency of endoscopic pancreatic sphincterotomy （EPS） combined with pancreatic duct stent for acute recurrent pancreatitis （ARP） caused by biliary microlithiasis. Methods A total of 71 patients were diagnosed as having ARP resulting from biliary microlithiasis from April 2005 to November 2016, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to different endoscopic therapy, EPS （ n = 34） and EST group （n = 37）, respectively. The rate of pancreatitis recurrence, post-ERCP pancreatitis （PEP） and biliary complications were compared by Chi-square test and the influencing factors of recurrence were evaluated by survival analysis. Results The follow-up time ranged from 2 to 108 months （median 21.5 months） in EPS group and ranged from 5 to 120 months （median 39 months） in EST group. Twelve months after endoscopic therapy, 2 patients in EPS group and 5 in EST group suffered recurrent pancreatitis （χ^2 = 0. 461, P = 0. 497）. Recurrence occurred in 13 patients in 60 months after endoscopic therapy, 4 patients in EPS group and 9 in EST group. Cox regression analysis indicated different endoscopic treatment （RR = 6. 808, 95% CI： 1. 389- 33. 356, P=0. 018） and type 2 diabetes （RR=0. 134, 95%CI： 0. 029-0. 608, P=0. 009） were statistically significant factors. There were no significant difference in incidence of PEP （20. 6% in EPS group, 10. 8% in EST group, χ^2 = 1. 294, P=0. 255） and biliary complications between two groups （ 11.8% in EPS group, 24. 3% in EST group, χ^2 = 1. 869, P = 0. 172）. Conclusion EPS combined with pancreatic stenting is effective for acute recurrent pancreatitis caused by microlithiasis. Type 2 diabetes may also lead to recurrence of acute pancreatitis.
出处
《中华消化内镜杂志》
CSCD
北大核心
2017年第8期554-559,共6页
Chinese Journal of Digestive Endoscopy
基金
首都市民健康项目培育（Z141100002114017）
关键词
胰腺炎
胆道微结石
胰管括约肌切开术
内镜下乳头括约肌切开术
Pancreatitis
Biliary microlithiasis
Endoscopic pancreatic sphincterotomy
Endoscopic sphincteropapillotomy
