發(fā)布時(shí)間：2018-04-29 04:26

  本文選題：非梗阻性急性膽源性胰腺炎 + 內(nèi)鏡治療��； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討非梗阻性急性膽源性胰腺炎早期行內(nèi)鏡治療的臨床療效。 方法：對(duì)2010年1月-2013年1月期間我院收住的95例非梗阻性急性膽源性胰腺炎(Acute biliary pancreatitis,ABP)患者，按2013年中國胰腺炎診治指南標(biāo)準(zhǔn)分型，其中輕型急性膽源性胰腺炎（Mild acutebiliary pancreatitis，，MABP）40例，重型急性膽源性胰腺炎（Severe acutebiliary pancreatltls，SABP）55例。分別對(duì)輕型和重癥非梗阻性ABP根據(jù)入院后采取不同的治療方法分為實(shí)驗(yàn)組（早期內(nèi)鏡治療組）和對(duì)照組（保守治療組），其中MABP實(shí)驗(yàn)組16例，對(duì)照組24例，SABP實(shí)驗(yàn)組28例，對(duì)照組27例。實(shí)驗(yàn)組在入院48小時(shí)內(nèi)行內(nèi)鏡治療，對(duì)照組行禁食、胃腸減壓、制酸、抑酶、抗感染、補(bǔ)液等保守治療。分別比較非梗阻性MABP和SABP實(shí)驗(yàn)組和對(duì)照組治療前后的腹痛緩解時(shí)間，白細(xì)胞、血尿淀粉酶、肝功能恢復(fù)正常時(shí)間，住院時(shí)間，住院費(fèi)用，治愈率，并發(fā)癥發(fā)生率和復(fù)發(fā)率等指標(biāo)，結(jié)果采用SPSS16.0進(jìn)行統(tǒng)計(jì)學(xué)處理。 結(jié)果：分別比較MABP和SABP實(shí)驗(yàn)組與對(duì)照組的結(jié)果。（1）非梗阻性MABP實(shí)驗(yàn)組與對(duì)照組結(jié)果對(duì)比，腹痛緩解時(shí)間（2.43±0.65，3.60±1.25）天，白細(xì)胞下降至正常時(shí)間（2.28±0.61，2.87±1.08）天，血AMS恢復(fù)至正常時(shí)間（2.36±0.50，2.77±1.07）天，尿AMS恢復(fù)至正常時(shí)間（2.43±0.51，3.10±0.67）天，肝功能恢復(fù)正常時(shí)間（0.5±0.31，0.8±0.66）天，住院時(shí)間（6.86±1.66，7.32±2.17）天，住院費(fèi)用（9538.27±2326.76，8351.86±2177.25）元，治愈率(93.75%,91.67%)，并發(fā)癥發(fā)生率（6.25%，8.33%），復(fù)發(fā)率（6.25%，29.17%），實(shí)驗(yàn)組除了復(fù)發(fā)率低于對(duì)照組，結(jié)果有統(tǒng)計(jì)學(xué)意義（P 0.05），其他各項(xiàng)結(jié)果無顯著性差異(PO．05)。 （2）非梗阻性SABP實(shí)驗(yàn)組與對(duì)照組結(jié)果對(duì)比，腹痛緩解時(shí)間（3.50±0.688，10.21±3.77）天，白細(xì)胞下降至正常（3.40±0.60，9.50±3.77）天，血AMS恢復(fù)至正常時(shí)間（3.60±0.68，5.67±1.38）天，尿AMS恢復(fù)至正常時(shí)間（4.10±0.64，6.17±2.95）天，肝功能下降至正常時(shí)間（1.10±0.57，3.52±1.98）天，住院時(shí)間（10．25±2.51，17.81±3.93）天，住院費(fèi)用（14672.25±3737.45，27780.67±6759.18）元，治愈率（96.43%，81.48%），并發(fā)癥發(fā)生率（7.14%，25.93%），復(fù)發(fā)率（10.71%，33.33%）,各項(xiàng)觀察指標(biāo)實(shí)驗(yàn)組明顯優(yōu)于對(duì)照組，兩組結(jié)果之間有統(tǒng)計(jì)學(xué)差異（P 0.05）。 結(jié)論：（1）非梗阻性MABP早期內(nèi)鏡治療無明顯優(yōu)勢(shì)，建議采取保守治療。（2）非梗阻性SABP發(fā)病48小時(shí)內(nèi)行內(nèi)鏡治療安全有效，具有創(chuàng)傷小，療效好，恢復(fù)快，費(fèi)用低，并發(fā)癥少和復(fù)發(fā)率低，是一種理想的治療方法，值得臨床推廣應(yīng)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 鹵0.65U 3.60 鹵1.25d, the leukopenia time was 2.28 鹵0.61U 2.87 鹵1.08d, the blood AMS returned to normal time 2.36 鹵0.502.77 鹵1.07d. The recovery time of AMS in urine was 2.43 鹵0.51 鹵3.10 鹵0.67) days, the normal time of recovery of liver function was 0.5 鹵0.31 / 0. 8 鹵0.66) days, the hospitalization time was 6.86 鹵1.66n 7.32 鹵2.17) days, and the cost of hospitalization was 9538.27 鹵2326.761 / 8351.86 鹵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 鹵0.688U 10.21 鹵3.77 days, the leukocyte was decreased to 3.40 鹵0.609.50 鹵3.77 days, the blood AMS returned to normal time was 3.60 鹵0.68 鹵5.67 鹵1.38 days, the urinary AMS returned to normal time was 4.10 鹵0.646.17 鹵2.95 days, the liver function decreased to normal time 1.10 鹵0.57v 3.52 鹵1.98 days. The hospitalization time was 10.25 鹵2.51 鹵17.81 鹵3.93 days, the hospitalization expenses were 14672.25 鹵3737.45 鹵27780.67 鹵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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R657.51

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