Nitsche R, Fölsch U R, Lüdtke R, Hilgers R A, Creutzfeldt W
I. Medizinische Universit-atsklinik Kiel, Schittenhelmstr. 12, Kiel D-24105, Germany.
Eur J Med Res. 1995 Dec 18;1(3):127-31.
In this prospective multicenter study, the effect of early ERCP within 72 hours after the beginning of symptoms in the treatment of acute biliary pancreatitis was investigated. 100 patients with acute biliary pancreatitis but without biliary sepsis or obstructive jaundice were randomized in this trial. 48 patients of the invasive group received urgent ERCP within 72 hours after the beginning of pain. 52 patients of the conventional group received ERCP only if biliary sepsis or obstructive jaundice occurred during the clinical course of the disease (which was the case in 10 patients). Sphincterotomy and stone extraction were undertaken if bile duct stones were identified during ERCP. In the invasive group, ERCP was successfully performed in 44 cases (92%). In 19 of these patients (43%), common bile duct stones were identified and a sphincterotomy was performed. The stones could be removed completely during the first ERCP examination in 16 cases. In the conventional group, 2 patients died from pancreatitis within 3 months, versus 4 patients in the invasive group. Cholecystitis occurred significantly more often in the conventional group (11 versus 4; odds ratio OR = 5.1), but no patient with cholecystitis or cholangitis died. Cholangitis (OR = 3.3) and sepsis (OR = 3.5) were slightly more frequent in the conventional group (not significant) while renal failure (OR = 0.5) and pulmonary failure (OR = 0.8) were slightly more frequent in the invasive group (not significant). Jaundice (6 patients) only occurred in the conventional group. In this multicenter study, it is concluded that early ERCP is not superior to conventional treatment in patients with acute biliary pancreatitis. On the other hand, patients with biliary complications (jaundice, sepsis, cholangitis) should receive urgent ERCP. However, most bile duct stones which initiate a pancreatitis pass spontaneously into the duodenum. The vast majority of patients suffering from biliary pancreatitis without biliary sepsis or obstructive jaundice require only elective ERCP when remaining bile duct stones are assumed. The lethality of biliary pancreatitis without initial biliary complications (sepsis, jaundice) tends to be elevated rather than diminished by emergency ERCP.
在这项前瞻性多中心研究中，调查了症状出现后72小时内早期内镜逆行胰胆管造影术（ERCP）在治疗急性胆源性胰腺炎中的效果。100例急性胆源性胰腺炎但无胆源性败血症或梗阻性黄疸的患者被纳入该试验并随机分组。侵入性治疗组的48例患者在疼痛开始后72小时内接受了紧急ERCP。传统治疗组的52例患者仅在疾病临床过程中出现胆源性败血症或梗阻性黄疸时（10例患者出现这种情况）才接受ERCP。如果在ERCP过程中发现胆管结石，则进行括约肌切开术和取石术。在侵入性治疗组中，44例（92%）患者成功进行了ERCP。在这些患者中的19例（43%）中，发现了胆总管结石并进行了括约肌切开术。16例患者在首次ERCP检查时结石被完全取出。在传统治疗组中，2例患者在3个月内死于胰腺炎，侵入性治疗组为4例。传统治疗组胆囊炎的发生率明显更高（11例对4例；优势比OR = 5.1），但没有胆囊炎或胆管炎患者死亡。传统治疗组胆管炎（OR = 3.3）和败血症（OR = 3.5）的发生率略高（无统计学意义），而侵入性治疗组肾衰竭（OR = 0.5）和肺衰竭（OR = 0.8）的发生率略高（无统计学意义）。黄疸（6例患者）仅出现在传统治疗组。在这项多中心研究中，得出的结论是，早期ERCP在急性胆源性胰腺炎患者中并不优于传统治疗。另一方面，有胆道并发症（黄疸、败血症、胆管炎）的患者应接受紧急ERCP。然而，大多数引发胰腺炎的胆管结石会自行排入十二指肠。绝大多数无胆源性败血症或梗阻性黄疸的胆源性胰腺炎患者，在假定存在残留胆管结石时仅需要择期ERCP。无初始胆道并发症（败血症、黄疸）的胆源性胰腺炎的致死率往往会因紧急ERCP而升高而非降低。
