目的：评价早期非手术治疗与早期内镜治疗是否对胆源性重症急性胰腺炎(biliary severe acute pancreatitis, BSAP)存在疗效差异。方法：采用前瞻性随机对照研究方法，将54例BSAP患者分成两组：早期内镜治疗组(early endoscopic intervention, EEI)：于发病72 h内进行内镜治疗；早期非手术治疗组(early conservative management, ECM)：于发病72 h内仅给予相关药物治疗，不进行内镜或手术治疗。观察2组入院1周内APACHE-II、SOFA和Balthazar CT评分，2组总的局部和全身并发症发生率以及病死率。结果：EEI组和ECM组APACHE-II评分均值(d0 P=0.14，d1 P=0.13，d2 P=0.20，d3 P=0.18，d7 P=0.43)、SOFA评分均值(d0 P=0.82，d1 P=0.56，d2 P=0.75，d3 P=0.77，d7 P=0.55)、Balthazar CT评分(d0 P=0.21，d7 P=0.27)、局部并发症发生率(25%vs 20%，P=0.66)、全身并发症发生率(37.5%vs 43.3%，P=0.67)和病死率(8.3%vs 15.4%，P=0.56)均无显著差异。结论：本研究未能证实早期内镜治疗可降低BSAP全身和局部并发症，早期内镜治疗与非手术治疗相比无显著性差异。%Objective To evaluate whether there is difference in efficacy between early non-surgical treat-ment and early endoscopic treatment in biliary severe acute pancreatitis (BSAP). Methods With a prospec-tive randomized study, 54 cases were divided into two groups: early endoscopic intervention group (EEI), in which endoscopic therapy was performed within 72 hours; and early conservative management group (ECM), in which patients took medication only within 72 hours, but not endoscopic or surgical treatment. Outcome measures included changes in APACHE-II, SOFA and Balthazar CT score during the first week after admission, incidence of local complications, and overall mor-bidity and mortality. Results No significant differences were found between the EEI and ECM groups about changes in mean APACHE-II score (d0 P=0.14,d1 P=0.13,d2 P=0.20,d3 P=0.18,d7 P=0.43), mean SOFA score (d0 P=0.82,d1 P=0.56,d2 P=0.75,d3 P=0.77,d7 P=0.55), mean Balthazar CT index (admission P=0.205, 7 days later P=0.269), incidences of local complications (25% vs. 20%, P=0.67), overall morbidity (37.5% vs. 43.3%, P=0.67), and mortality (8.3% vs. 15.4%, P=0.56). Conclusion The present study failed to confirm early endoscopic therapy may reduce the BSAP systemic and local complications. Early endoscopic therapy shows no significant differences in superiority of the result.
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