急性复发性胰腺炎患者的病因分析及内镜治疗探讨

The causes of acute recurrent pancreatitis and endoscopic therapy

  • 摘要:
    目的 分析急性复发性胰腺炎(RAP)患者的病因及内镜治疗疗效、预后转归情况。
    方法 回顾性分析2018年10月—2020年10月收治的127例RAP患者的临床资料。按不同治疗手段将患者分为内镜组(内镜治疗, n=46)、药物组(药物治疗, n=33)、手术组(手术治疗, n=48)。分析3组病因,比较3组患者入院前平均复发次数、距初次发作时间、术前3年内复发率。分析3组预后、复发及死亡情况。
    结果 RAP病因中以胆道结石最为常见,占30.71%(39/127), 其次为高脂血症,占24.41%(31/127)。3组病因、入院前平均复发次数、距初次发作时间、术前3年内复发率、治愈率、好转率及无效率比较,差异均无统计学意义(P>0.05)。内镜组患者经治疗后均治愈或好转,无病情加重者。内镜组术后身体、角色、情绪、认知、社会功能评分均高于药物组、手术组,差异有统计学意义(P < 0.05)。随访期间,内镜组复发率低于药物组、手术组,差异有统计学意义(P < 0.05)。
    结论 RAP的主要致病因素为胆源性因素、高脂血症、酒精。RAP患者经内镜治疗后可有效降低复发率,改善预后。

     

    Abstract:
    Objective To analyze the causes of patients with acute recurrent pancreatitis (RAP), efficacy of endoscopic therapy and prognosis.
    Methods The clinical data of 127 patients with RAP admitted from October 2018 to October 2020 were retrospectively analyzed. According to different treatment methods, the patients were divided into endoscopic group (endoscopic treatment, n=46), drug group (drug treatment, n=33) and surgery group (surgical treatment, n=48). The causes of the three groups were analyzed. The average recurrence times before admission, the time from the first attack to admission, and the recurrence rate within 3 years before operation were compared among the three groups. The prognosis, recurrence and death of the three groups were analyzed.
    Results Biliary calculus was the most common cause of RAP, accounting for 30.71% (39/127), followed by hyperlipidemia, accounting for 24.41% (31/127). There were no significant differences in etiology, average recurrence times before admission, time from the first attack to admission, recurrence rate within 3 years before operation, cure rate, improvement rate and ineffective rate among the three groups (P>0.05). All patients in the endoscopic group were cured or improved after treatment, without aggravation. The physical, role, emotion, cognition and social function scores in the endoscopic group were significantly higher than those in the drug group and surgery group (P < 0.05). During follow-up, the recurrence rate of the endoscopy group was significantly lower than that of the drug group and surgery group (P < 0.05).
    Conclusion The main pathogenic factors of RAP are biliary factor, hyperlipidemia and alcohol. Endoscopic treatment can effectively reduce the recurrence rate and improve the prognosis of RAP patients.

     

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