内镜逆行胆道引流对自身免疫性胰腺炎伴梗阻性黄疸患者的疗效及预后研究

Effectiveness and Prognosis Study of ERCP Treatment in Patients with AIP accompanied by Obstructive Jaundice

摘要:

目的：本研究旨在探讨内镜逆行胆道引流在治疗合并严重梗阻性黄疸的AIP中的意义。 方法：回顾性分析2010年-2023年在海军军医大学第一附属医院的69例合并梗阻性黄疸的AIP且同时接受类固醇激素治疗患者的临床资料。比较合并严重梗阻性黄疸的AIP患者在接受类固醇+内镜逆行胰胆管造影（ERCP）和单独使用类固醇的近期疗效、远期疗效、住院费用及ERCP术后并发症的结果。 结果：本研究共纳入69例患者，32例行ERCP术患者的年龄为（62.78±11.21）岁；住院时间为（10.38±4.56）日；住院费用为（34816.57±11688.85）元；9例（28.1%）复发；37例未行ERCP术患者年龄为（55.41±2.15）岁；住院时间为（8.95±4.99）日；住院费用为（16518.5±6544.37）元；8例（21.6%）复发。在两组患者中，年龄的差距在统计学上是明显的（P=0.015）；ERCP手术的实施与住院时间的关系在统计学上并没有明确的区别（p=0.219），然而，它却会大幅度提高病人的住院费用（p<0.001）；两组的复发率在统计学上并没有明确的区别（p=0.266）。ERCP术后并发症发生率为25%，2例（6.25%）患者发生术后胰腺炎，均为轻型胰腺炎；1例（3.13%）患者出现出血，4例（12.50%）患者出现感染，1例（3.13%）患者发生支架脱落。两组患者的IgG4、总胆红素、直接胆红素、丙氨酸氨基转移酶在ERCP术后或行激素治疗后1个月、3个月、6个月、12个月及24个月的指标变化无统计学差异（p>0.05）。 结论：内镜逆行胆道引流对合并梗阻性黄疸的AIP的治疗对患者的远期疗效及复发率并无明显增益，反而增加患者发生术后并发症的风险及患者家庭将承担更多医疗费用，确诊梗阻性黄疸的AIP患者单纯使用激素治疗是安全可行的。

Abstract:

Objective This study aims to investigate the significance of Endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of AIP (autoimmune pancreatitis) with concomitant severe obstructive jaundice.Methods A retrospective analysis of 69 patients with AIP and concomitant obstructive jaundice who received corticosteroid therapy at the Changhai Hospital from 2010 to 2023. The study compared the short-term and long-term efficacy, hospitalization costs, and ERCP complications between patients with severe obstructive jaundice AIP who received corticosteroids plus ERCP and those who received corticosteroids alone.Results This study included 69 patients, with 32 patients undergoing ERCP, whose average age was (62.78±11.21) years, average hospital stay was (10.38±4.56) days, and average hospitalization cost was (34816.57±11688.85) CNY. Among them, 9 patients (28.1%) experienced recurrence. The 37 patients who did not undergo ERCP had an average age of (55.41±2.15) years, average hospital stay of (8.95±4.99) days, and average hospitalization cost of (16518.5±6544.37) CNY, with 8 patients (21.6%) experiencing recurrence. The age difference between the two groups was statistically significant (P=0.015), but there was no clear difference in hospital stay between the two groups (p=0.219).However,ERCP significantly increased hospitalization costs (p<0.001). The recurrence rates between the two groups were not statistically significant (p=0.266). The incidence of postoperative complications was 25%, with 2 patients (6.25%) developing postoperative pancreatitis (both mild cases), 1 patient (3.13%) experiencing bleeding, 4 patients (12.50%) developing infections, and 1 patient (3.13%) experiencing stent displacement. There were no significant differences in IgG4, total bilirubin, direct bilirubin, and alanine aminotransferase levels between the two groups at ERCP or after steroid treatment at 1, 3, 6, 12, and 24 months (p>0.05). Conclusion ERCP with biliary stenting for the treatment of obstructive jaundice in AIP patients has not shown significant benefits in long-term efficacy or reduced recurrence rates. Instead, it may increase the risk of postoperative complications, such as infection, bleeding, and perforation, and result in higher medical expenses for patients" families. Therefore, for AIP patients diagnosed with obstructive jaundice, steroid therapy alone is a safe and feasible option. However, it is important to note that each patient"s situation is unique, and treatment plans should be individualized based on their specific condition.