急性胆源性胰腺炎(ABP)是由于胆汁异常回流到胰管而发生的急性炎症反应。激活胰腺消化酶产生胰腺自动消化。
■探讨内镜逆行胰胆管造影术(ERCP)治疗轻中度ABP患者与腹腔镜手术相比的优势,研究ABP复发的危险因素,构建风险预测模型,以辅助解决临床决策和改善预后。
■对2019年1月1日至2022年7月1日在宁夏医科大学总医院接受治疗的轻、中重度ABP患者进行回顾性分析。根据纳入标准和排除标准共纳入327例患者。根据治疗方式的不同,他们被分为ERCP治疗组(n=239)和腹腔镜手术治疗组(n=88).进行统计学分析,比较两组患者术前、术后血常规、血生化指标水平的差异。以及从临床症状中恢复的时间,住院时间,两组患者的术后并发症。将参加随访的280例患者根据是否复发分为复发组(n=130)和未复发组(n=150)。采用独立样本t检验和二元logistic回归分析胆源性胰腺炎复发的单因素和危险因素。然后构建模型并评估模型的预测精度。
■术后第2天,局部并发症的发生率,BalthazarCT评分,经ERCP治疗组患者的镇痛次数低于经腹腔镜手术治疗组(P<0.001),和抗生素的持续时间,酶抑制药物,禁食,ERCP组的住院时间短于腹腔镜手术组(P<0.001)。个人历史,γ-谷氨酰转肽酶(GGT),和治疗方式是胆源性胰腺炎复发的危险因素。结合GGT构建的模型,个人历史,与GGT模型相比,治疗方式对疾病复发的预测能力最好,个人历史,和单独的治疗方式(ROC曲线下面积0.815)。
■与腹腔镜手术组相比,ERCP治疗能有效缓解ABP患者的症状,提前恢复胃肠功能。减少住院时间和相关并发症。个人历史,GGT,和治疗方式是胆源性胰腺炎复发的危险因素。患者可以通过戒烟和戒酒来防止复发,吃健康的饮食,适当地锻炼。
Acute biliary pancreatitis (ABP) is an acute inflammatory reaction that occurs as a result of abnormal reflux of bile into the pancreatic duct, which activates pancreatic digestive enzymes to produce pancreatic auto-digestion.
UNASSIGNED: To explore the advantages of Endoscopic Retrograde Cholangiopancreatography (ERCP) treatment compared with laparoscopic surgery in the management of patients with mild and moderately severe ABP, and to study the risk factors for recurrence of ABP and construct a risk prediction model to assist in resolving clinical decision-making and improving prognosis.
UNASSIGNED: Patients with mild and moderately severe ABP treated at General Hospital of Ningxia Medical University from January 1, 2019 to July 1, 2022 were reviewed. A total of 327 patients were enrolled according to the inclusion criteria and exclusion criteria. According to the different treatment modalities, they were divided into the group treated via ERCP (n = 239) and the group treated via laparoscopic surgery (n = 88). Statistical analyses were performed to compare the differences between the average levels of preoperative and postoperative blood routine and blood biochemical indexes, as well as the time of recovery from clinical symptoms, length of hospital stay, and postoperative complications between the two groups of patients. The 280 patients who participated in the follow-up were divided into the recurrence group (n = 130) and the non-recurrence group (n = 150) according to whether they had recurrence or not. Independent samples t-test and binary logistic regression were used to analyze the causative monofactors and risk factors of recurrent biliary pancreatitis, and then to construct the model and assess the predictive accuracy of the model.
UNASSIGNED: On postoperative day 2, the incidence of local complications, Balthazar CT score, and the number of analgesia were lower in the patients in the group treated by ERCP than in the group treated by laparoscopic surgery (P < 0.001), and the duration of antibiotics, enzyme-suppressing medication, fasting, and hospital stay were shorter in the patients in the group treated by ERCP than in the group treated by laparoscopic surgery (P < 0.001). Personal history, gamma glutamyl transpeptidase (GGT), and treatment modality are risk factors for recurrence of biliary pancreatitis. The model constructed by combining GGT, personal history, and treatment modality had the best predictive ability for disease recurrence compared with the model with GGT, personal history, and treatment modality alone (area under the ROC curve 0.815).
UNASSIGNED: Compared with the laparoscopic surgery group, ERCP treatment can effectively relieve symptoms and restore gastrointestinal function in advance in patients with ABP, and reduce hospitalisation time and related complications. Personal history, GGT, and treatment modality are risk factors for recurrence of biliary pancreatitis. Patients can prevent recurrence by abstaining from smoking and alcohol, eating a healthy diet, and exercising appropriately.