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中华消化病与影像杂志(电子版)

中华消化病与影像杂志(电子版) ›› 2024, Vol. 14 ›› Issue (05) : 437 -441. doi: 10.3877/cma.j.issn.2095-2015.2024.05.011

论著

通腑泻浊法联合生长抑素对内镜逆行胰胆管造影治疗的急性胆源性胰腺炎患者预后的影响
商倩1, 罗静1, 卓振山1, 苗园园1, 吴静1, 廖振林1,†()   
  1. 1. 071000　河北省，保定市第一医院消化内科
  • 收稿日期:2024-01-16 出版日期:2024-10-01
  • 通信作者: 廖振林
  • 基金资助:
    保定市科学技术局社发类项目(1941ZF028)

Effect of dredging fu-organs and purging turbidity therapy combined with somatostatin on prognosis quality of patients with acute biliary pancreatitis treated by endoscopic retrograde cholangiopancreatography

Qian Shang1, Jing Luo1, Zhenshan Zhuo1, Yuanyuan Miao1, Jing Wu1, Zhenlin Liao1,†()   

  1. 1. Department of Gastroenterology, The First Hospital of Baoding City, Baoding 071000, China
  • Received:2024-01-16 Published:2024-10-01
  • Corresponding author: Zhenlin Liao
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引用本文：

商倩, 罗静, 卓振山, 苗园园, 吴静, 廖振林. 通腑泻浊法联合生长抑素对内镜逆行胰胆管造影治疗的急性胆源性胰腺炎患者预后的影响[J]. 中华消化病与影像杂志(电子版), 2024, 14(05): 437-441.

Qian Shang, Jing Luo, Zhenshan Zhuo, Yuanyuan Miao, Jing Wu, Zhenlin Liao. Effect of dredging fu-organs and purging turbidity therapy combined with somatostatin on prognosis quality of patients with acute biliary pancreatitis treated by endoscopic retrograde cholangiopancreatography[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(05): 437-441.

目的

分析通腑泻浊法联合生长抑素对经内镜逆行胰胆管造影（ERCP）治疗的急性胆源性胰腺炎（ABP）患者预后质量的影响。

方法

纳入保定市第一医院2019年4月至2020年7月收治的120例ABP患者，使用简单随机法分别纳入联合组（n=60）、对照组（n=60）。2组均接受ERCP治疗，术后给予生长抑素静注，联合组加用通腑泻浊法治疗。比较2组症状恢复时间，并比较其术前、术后血清淀粉酶、炎症指标、肝功能变化，评估2组临床疗效和并发症发生率。

结果

联合组腹痛缓解时间、腹胀缓解时间、血淀粉酶恢复正常时间均低于对照组（P<0.05）。联合组术后12 h、24 h、3 d血淀粉酶低于对照组（P<0.05）。术后3 d，联合组WBC、PCT、CRP均低于对照组（P<0.05）；ALT、AST、GGT、DBIL均低于对照组（P<0.05）。联合组临床治愈率较对照组更高（58.33%比36.67%，P<0.05），术后并发症较对照组更低（5.00%比16.67%，P<0.05）。

结论

ERCP术后在生长抑素的基础上增加通腑泻浊法治疗，能够缩短ABP患者症状恢复时间、减轻炎症反应、改善肝功能，有助于临床疗效的提高和并发症的减少。

关键词: 急性胆源性胰腺炎, 通腑泻浊法, 生长抑素, 内镜逆行胰胆管造影
Objective

To analyze the effect of dredging fu-organs and purging turbidity combined with somatostatin on the prognosis quality of patients with acute biliary pancreatitis (ABP) treated by endoscopic retrograde cholangiopancreatography (ERCP).

Methods

A total of 120 patients with ABP admitted to the First Hospital of Baoding City from April 2019 to July 2020 were randomly divided into the combined group (n=60) and the control group (n=60). Both groups were treated with ERCP, and somatostatin was injected intravenously after operation, while the combined group was treated with the method of dredging fu-organs and purging turbidity. The recovery time of symptoms was compared between the two groups, and the changes of serum amylase, inflammatory index and liver function before and after operation were compared, and the clinical efficacy and complication rate of the two groups were evaluated.

Results

The time to relieve abdominal pain, abdominal distension and blood amylase in the combined group were shorter than those in the control group (P<0.05). The serum amylase in the combined group was lower than that in the control group at 12 h, 24 h and 3 d after operation (P<0.05). The WBC, PCT and CRP in the combined group were lower than those in the control group at 3 days after operation (P<0.05). ALT, AST, GGT and DBIL in the combined group were lower than those in the control group on the 3rd day after operation (P<0.05). The clinical cure rate of the combined group was higher than that of the control group (58.33% vs. 36.67%, P<0.05). The postoperative complications in the combined group were lower than those in the control group (5.00% vs. 16.67%, P<0.05).

Conclusion

For ABP patients, adding the therapy of dredging fu-organs and purging turbidity on the basis of somatostatin after ERCP can shorten the recovery time of symptoms, reduce inflammatory reaction and improve liver function, which is helpful to improve clinical efficacy and reduce the incidence of complications.

Key words: Acute biliary pancreatitis, Dredging fu-organs and purging turbidity, Somatostatin, Endoscopic retrograde cholangiopancreatography
表1 2组患者一般临床资料比较
组别 例数 年龄(岁,±s) 胆总管直径(cm,±s) 性别[例(%)] 病因[例(%)]
男 女 胆总管结石 其他
联合组 60 42.75±4.18 0.74±0.09 39(65.00) 21(35.00) 44(73.33) 16(26.67)
对照组 60 43.13±4.06 0.71±0.12 43(71.67) 17(28.33) 42(70.00) 18(30.00)
t/χ2值   0.505 1.549 0.616 0.164
P值   0.614 0.124 0.432 0.685
表2 2组患者症状恢复时间比较（±s）
组别 例数 腹痛缓解时间(h) 腹胀缓解时间(h) 血淀粉酶恢复正常时间(d)
联合组 60 3.84±0.71 6.18±0.66 1.89±0.31
对照组 60 5.26±0.92 9.71±1.37 3.23±0.44
t值   9.465 17.981 19.284
P值   <0.001 <0.001 <0.001
表3 2组患者血淀粉酶变化比较（U/L，±s）
组别 例数 术前 术后12 h 术后24 h 术后3 d 术后7 d
联合组 60 214.89±36.95 152.68±24.71* 121.36±16.85* 90.81±9.17* 87.62±8.06
对照组 60 217.60±35.42 177.89±26.85* 140.93±19.42* 109.25±11.38* 88.04±8.19
t值   0.410 5.352 5.896 9.773 0.283
P值   0.682 <0.001 <0.001 <0.001 0.778
表4 2组患者炎症指标变化比较（±s）
组别 例数 WBC(×109/L) PCT(ng/mL) CRP(mg/L)
术前 术后3 d 术前 术后3 d 术前 术后3 d
联合组 60 16.24±2.95 9.15±1.17* 11.85±1.26 1.63±0.15* 166.95±38.41 91.97±25.18*
对照组 60 16.33±2.71 10.36±1.39* 11.69±1.20 2.59±0.24* 167.15±36.88 115.24±29.62*
t值   0.174 5.159 0.712 26.274 0.029 4.636
P值   0.862 <0.001 0.478 <0.001 0.977 <0.001
表5 2组患者肝功能指标变化比较（±s）
组别 例数 ALT(U/L) AST(U/L) GGT(U/L) DBIL(μmol/L)
术前 术后3 d 术前 术后3 d 术前 术后3 d 术前 术后3 d
联合组 60 195.59±35.71 51.63±8.55* 169.24±33.19 45.26±6.15* 127.29±18.54 46.36±7.16* 19.66±2.25 8.15±1.74*
对照组 60 196.48±34.39 62.06±10.14* 170.18±32.65 52.08±9.37* 126.68±17.99 53.51±8.74* 19.73±2.48 8.96±2.08*
t值   0.139 6.091 0.156 4.713 0.183 4.902 0.162 2.314
P值   0.890 <0.001 0.876 <0.001 0.855 <0.001 0.872 0.022
表6 2组患者术后临床疗效比较[例（%）]
组别 例数 临床治愈 显效 有效 无效 总有效
联合组 60 35(58.33) 14(23.33) 5(8.33) 6(10.00) 54(90.00)
对照组 60 22(36.67) 16(26.67) 7(11.67) 15(25.00) 45(75.00)
χ2值   5.648       4.675
P值   0.018       0.031
表7 2组患者术后并发症比较[例（%）]
组别 例数 胰腺囊肿 胰腺脓肿 胆管炎 胆囊炎 合计
联合组 60 1(1.67) 1(1.67) 0 1(1.67) 3(5.00)*
对照组 60 2(3.33) 4(6.67) 3(5.00) 1(1.67) 10(16.67)
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