Jover R, Llach J, Bordas J M, Mas A, Salmerón J M, Navarro S, Terés J
Servicio de Gastroenterología, Hospital Clínic i Provincial, Barcelona.
Gastroenterol Hepatol. 1997 Aug-Sep;20(7):344-6.
There are evidence indicating that endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP+S) reduces the rate of complications in patients with severe acute biliary pancreatitis (ABP). The aim of this study was to analyze our experience in the treatment of severe ABP with ERCP+S and compare the evolution of the patients treated early (3 days or less following admission) with those treated late (after the 3rd day). A retrospective review of the clinical histories of the 16 patients with severe ABP treated with ERCP+S over the last two years is presented, analyzing their clinical features on admission and evolution. Biliary stones or biliary sludge was observed in 11 cases (69%). Nine patients had undergone early, and 7 late, ERCP+S. The patients of the latter group presented a greater number of complications during evolution than the former group (43% vs 0%; p = 0.025). The mortality of the patients of the late ERCP+S was also greater although without statistical significance (28.6% vs 0%; p = 0.15). No complication secondary to ERCP+S was detected. These findings confirm the fact that ERCP+S performed early in severe ABP significantly reduces the number of complications and is associated with a lower mortality.
有证据表明，内镜逆行胰胆管造影术联合括约肌切开术（ERCP+S）可降低重症急性胆源性胰腺炎（ABP）患者的并发症发生率。本研究的目的是分析我们采用ERCP+S治疗重症ABP的经验，并比较早期（入院后3天或更短时间）治疗的患者与晚期（第3天后）治疗的患者的病情演变。本文回顾性分析了过去两年中16例接受ERCP+S治疗的重症ABP患者的临床病史，分析了他们入院时的临床特征和病情演变。11例（69%）观察到胆石症或胆泥。9例患者接受了早期ERCP+S，7例接受了晚期ERCP+S。后一组患者在病情演变过程中出现的并发症比前一组更多（43%对0%；p=0.025）。晚期ERCP+S患者的死亡率也更高，尽管无统计学意义（28.6%对0%；p=0.15）。未检测到ERCP+S继发的并发症。这些发现证实了在重症ABP早期进行ERCP+S可显著减少并发症数量并降低死亡率这一事实。
