急性復(fù)發(fā)性胰腺炎病因、臨床特征及診療的回顧性分析
發(fā)布時(shí)間：2018-09-06 19:09
【摘要】：目的:通過(guò)總結(jié)我院急性復(fù)發(fā)性胰腺炎(Acute recurrent pancreatitis,ARP)患者的病因、相關(guān)特征(性別、年齡、復(fù)發(fā)次數(shù)及時(shí)間間隔、相關(guān)實(shí)驗(yàn)室生化指標(biāo)等)及診療方法的選擇讓臨床工作者對(duì)ARP有更深刻的認(rèn)識(shí),從而指導(dǎo)臨床早期干預(yù),明確并去除病因,從而提高治愈率,降低胰腺炎患者的復(fù)發(fā)率、并發(fā)癥和病死率,減輕患者的痛苦,改善預(yù)后。方法:收集2015年1月至2016年5月在皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院消化內(nèi)科住院的急性胰腺炎(Acute pancreatitis,AP)患者的病例資料(共394例),其中有86例患者AP反復(fù)發(fā)作,歸為復(fù)發(fā)組(Relapse Group,RG),其余歸為首發(fā)組(Primary Group,PG),分析比較兩組患者的可能致病因素和臨床特征,以及對(duì)于ARP患者早期明確判別可能的致病因素及針對(duì)致病因素選擇適當(dāng)有效的治療方法。結(jié)果:共收集我院AP患者394例,(1)一般資料性別比較:其中首發(fā)組有308例(78.2%),男性156例(50.6%),女性152例(49.4%);復(fù)發(fā)組有86例(21.8%),男女各有43例,兩組性別差異χ2=0.011,P0.05,無(wú)統(tǒng)計(jì)學(xué)意義。(2)一般資料年齡比較:PG平均年齡55.955±16.166歲,RG平均年齡53.826±16.919歲,兩組年齡差異t=1.069,P=0.2860.05,無(wú)統(tǒng)計(jì)學(xué)意義。(3)復(fù)發(fā)次數(shù)比較:復(fù)發(fā)一次有62例(72.1%),其中男性30例(48.4%),女性32例(51.6%),復(fù)發(fā)多次(≥2次)有24例(27.9%),其中男性13例(54.2%),女性11例(45.8%),復(fù)發(fā)次數(shù)與性別的差異χ2=0.2312,P0.05,無(wú)統(tǒng)計(jì)學(xué)意義。(4)復(fù)發(fā)時(shí)間間隔比較:復(fù)發(fā)時(shí)間間隔=6月有59人,占68.6%,其中男性25例(42.4%),女性34例(57.6%),復(fù)發(fā)間隔6月有27人,占31.4%,其中男性18人(66.7%),女性9例(33.3%),復(fù)發(fā)時(shí)間間隔性別差異χ2=4.37,P0.05,有統(tǒng)計(jì)學(xué)意義。(5)可能致病因素比較:PG中膽源性有208例(占67.5%),高脂血癥性有35(占11.4%),酒精性有30例(占9.7%)其他因素有35例(占11.4%),RG中膽源性有50例(占58.1%),高脂血癥性有19例(占22.1%),酒精性有8例(占9.3%),其他因素有9例(占10.5%),兩組胰腺炎前三位致病因素均為膽源性(χ2=2.62,P0.05)、高脂血癥性(χ2=6.54,P0.05)、酒精性(χ2=0.02,P0.05),其中兩組致病因素為高脂血癥性的差異有統(tǒng)計(jì)學(xué)意義,為胰腺炎復(fù)發(fā)高危因素。復(fù)發(fā)組中重癥急性胰腺炎(Severe acute pancreatitis,SAP)有19例,其中膽源性13例,其他因素有6例,輕癥AP有67例,其中膽源性有37例,非膽源性有30例,膽源性因素與胰腺炎輕重的比較χ2=1.06,P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。(6)實(shí)驗(yàn)室指標(biāo)比較:入院時(shí)首發(fā)組白細(xì)胞平均值為11.485±4.798(×109/L),復(fù)發(fā)組平均值為11.038±3.764(×109/L),t=0.884 p=0.3770.05無(wú)統(tǒng)計(jì)學(xué)意義;入院時(shí)血鈣首發(fā)組平均值為2.069±0.258(mmol/L),復(fù)發(fā)組平均值為2.122±0.233(mmol/L),t=1.702 P=0.090.05,無(wú)統(tǒng)計(jì)學(xué)意義;入院時(shí)甘油三酯首發(fā)組平均值為1.448±1.426(mmol/L),復(fù)發(fā)組平均值為1.402±1.291(mmol/L),t=0.244 P=0.8080.05,無(wú)統(tǒng)計(jì)學(xué)意義。(7)診斷及治療:急性復(fù)發(fā)性胰腺炎患者多由腹部B超、MRCP、超聲內(nèi)鏡、ERCP(endoscopic retrograde cholangiopancreatography)等明確診斷病因,本研究中有3例患者第一次發(fā)作未查明原因,復(fù)發(fā)1次或多次再行ERCP檢查診斷為膽總管下端小結(jié)石、胰腺分裂、Oddi括約肌功能障礙(Sphincter of Oddi dysfunction,SOD),1例因膽囊結(jié)石反復(fù)發(fā)作AP,行LC術(shù)后病理診斷膽囊癌;ARP的治療方法有內(nèi)科綜合治療、內(nèi)鏡下介入治療及外科手術(shù)治療等。結(jié)論:1.我院ARP患者首三位致病因素為膽源性、高脂血癥性、酒精性,其中高脂血癥性為AP復(fù)發(fā)高危因素;2.內(nèi)鏡下介入微創(chuàng)治療(如ERCP術(shù)、EST術(shù)、膽胰管支架置入術(shù)等),在病因的診斷、早期有效的干預(yù)、預(yù)防復(fù)發(fā)等方面起著重大的作用,尤其是膽源性胰腺炎和特發(fā)性胰腺炎(Idiopathic pancreatitis,IP),值得臨床推廣應(yīng)用;3.復(fù)發(fā)組中患者多于半年內(nèi)復(fù)發(fā),且女性患者多見。
[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.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R576
本文編號(hào)：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.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R576
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