老年急性胆源性胰腺炎早期内镜治疗疗效观察

摘要

Objective To investigate the clinical efficacy of the early endoscopic treatment of elderly patients with acute gallstone pancreatitis. Methods 58 cases of elderly patients with acute gallstone pancreatitis patients were selected and divided into observation group and the control group,the control group took the conservative treatment,the observation group was hospitalized in 48 hours and accepted ERCP/ EST/ ENBD treatment. Preoperative and postoperative 1 week,1 month,TNF-α,IL-6,IL-8 levels and APACHE II score were detected in patients and the occurrence of complications were observed. TNF-α,IL-8 of control group after treatment significantly decreased than before treatment(P<0.05),IL-6 did not show a significant decrease(P>0.05). TNF-α,IL-6,IL-8 of observation group after treatment showed a significant difference than before treatment(P<0.01),TNF-α,IL-6 significantly decreased compared with the control group after treatment(P<0.05),IL-8 significantly decreased than the control group after treatment(P<0.01).After a week of treatment APACHE II score were significantly decreased in the observation group before treatment and after treatment compared with the control group decreased significantly(P<0.05),but in the control group it decreased after a week of treatment, which had no significant difference(P>0 .05). 1 month after treatment of the control group and the observation group showed significantly decreased than before treatment(P<0.01),the observation group therapy significantly decreased(P<0.01)in 1 month compared with the control group after treatment. Observation group,only one case of abdominal infection,the incidence of complications was significantly lower than the control group(P<0.05). Conclusion Endoscopic therapy for elderly patients with acute gallstone pancreatitis patients,can effectively slow disease progression and reduce the incidence of late complications with better application prospects.%　　目的探讨早期内镜治疗对老年急性胆源性胰腺炎的临床疗效。方法老年急性胆源性胰腺炎患者58例，分为观察组和对照组，对照组采取内科保守治疗，观察组于入院48h内行ERCP/EST/ENBD治疗。术前及术后1周、1个月分别检测TNF-α、IL-6、IL-8水平，作APACHE Ⅱ评分并统计并发症。结果对照组治疗后TNF-α、IL-8显著下降（P<0.05），IL-6无明显下降（P>0.05），观察组治疗后TNF-α、IL-6、IL-8均显著下降（P<0.01），且较对照组幅度大。APACHE II评分观察组治疗1周后较治疗前有显著下降（P<0.01），对照组治疗1周后虽有下降，但差异无统计学意义。观察组出现腹腔感染1例，对照组出现MODS1例，休克1例，胰腺假性囊肿1例，腹腔感染3例，并发症的发生率观察组低于对照组（P<0.05）。结论针对老年急性胆源性胰腺炎患者早期采用内镜治疗，可有效减缓疾病进展并减少后期并发症的发生，有较好的应用前景。