胰管支架置入在预测为重症急性胆源性胰腺炎中的疗效分析

Efficacy of pancreatic stent placement for predicted severe acute biliary pancreatitis

摘要:

目的 探讨胰管支架置入在预测为重症急性胆源性胰腺炎中的疗效。方法 回顾性收集2017年1月1日至2021年6月30日就诊于西湖大学医学院附属杭州市第一人民医院消化内科预测为重症急性胆源性胰腺炎，并接受内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography， ERCP）治疗的病例。其中，将ERCP术中置入胰管支架的31例病例纳入观察组，于同期病例中选择31例ERCP术中未放置胰管支架的病例纳入对照组。比较两组患者术后1周和2周时炎症指标、肝功能指标和血清淀粉酶水平差异，同时比较两组患者临床改善情况（血清淀粉酶恢复正常时间、腹痛缓解时间、胰周积液好转时间），住院时间和费用以及预后情况（远期并发症发生率、需内镜下引流或内镜下清创率）。结果 观察组和对照组患者的年龄、性别构成比、术前急性胰腺炎严重程度评分、肝功能指标、炎症性指标、首次进行ERCP时间差异均无统计学意义（P>0.05）。两组患者接受ERCP术后1周和2周时炎症指标、肝功能指标和血清淀粉酶水平差异均无统计学意义（P>0.05）。观察组和对照组患者血清淀粉酶恢复正常时间分别为3.5（1，5） d和5.0（3，6） d （Z=-2.20，P=0.028），腹痛缓解时间分别为4.0（2.5，7.0） d和5.0（4.0，8.8） d （Z=-3.15，P=0.002），胰周积液好转时间分别为（25.3±1.5） d和（27.8±2.2） d （t=-0.84，P=0.407），住院时间分别为28（19， 49） d和40（27， 70） d （Z=-2.03，P=0.043），住院总费分别为8.1（5.9，10.9）万元和9.8（6.9，17.3）万元 （Z=2.02，P=0.043）。观察组和对照组远期并发症发生率分别为22.6%（7/31）和54.8%（17/31） （χ2=6.80，P=0.009），需内镜引流或清创率分别为16.1%（5/31）和38.7%（12/31） （χ2=3.97，P=0.046）。结论 对于预测为重症急性胆源性胰腺炎患者，内镜下解除胆道梗阻的同时放置胰管支架引流胰液降低胰管内压力，不仅可以加快缓解患者的临床症状，还可以有效改善患者的预后。

Abstract:

Objective To evaluate the efficacy of pancreatic stent placement for predicted severe acute biliary pancreatitis (SABP). Methods Data of patients predicted as having SABP , who receive endoscopic retrograde cholangiopancreatography (ERCP) from January 1, 2017 to June 30, 2021 at Affiliated Hangzhou First People''s Hospital, School of Medicine, Westlake University were reviewed. Pancreatic stents were placed in 31 patients during ERCP (the observation group), and 31 other patients who received ERCP without pancreatic duct stents in the same period were included as the control group. Inflammation indices, liver function indices and serum amylase of the two groups 1 week and 2 weeks after the operation were compared. The clinical improvement (time for the serum amylase return to normal, relief time of abdominal pain, improvement time of peripancreatic effusion), length of hospital stay and cost, and prognosis (long-term complication incidence, incidence of endoscopic drainage or debridement) were compared. Results There were no significant differences in age, gender composition, preoperative severity score, liver function indices, inflammatory indices or time of first ERCP between the observation group and the control group (P>0.05). There were no significant differences in inflammatory indices, liver function indices or serum amylase between the two groups at 1 week and 2 weeks after receiving ERCP (P>0.05). The time for amylase to return to normal was 3.5 (1, 5) d and 5.0 (3, 6) d (Z=-2.20, P=0.028), the time for pain relief was 4.0 (2.5,7.0) d and 5.0 (4.0, 8.8) d (Z=-3.15,P=0.002), the improvement time for peripancreatic effusion was 25.3±1.5 d and 27.8±2.2 d (t=-0.84, P=0.407) , the hospital stay was 28 (19, 49) d and 40 (27, 70) d (Z=-2.03,P=0.043), and the total hospital cost was 81 (59,109) thousand yuan and 98 (69,173) thousand yuan (Z=2.02,P=0.043), respectively, in the observation group and the control group. The incidences of long-term complications in the observation group and the control group were 22.6% (7/31) and 54.8% (17/31) (χ2=6.80, P=0.009), respectively, and the incidences of endoscopic drainage or debridement were 16.1% (5/31) and 38.7% (12/31), respectively (χ2=3.97,P=0.046). Conclusion For patients with predicted severe acute biliary pancreatitis, endoscopic removal of biliary obstruction and placement of pancreatic stent to drain pancreatic juice to reduce pancreatic duct hypertension could accelerate the relief of patients'' clinical symptoms and improve their prognosis.