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【文摘发布】对于急性胆原性胰腺炎早期内镜治
Ann Surg. 2007 January; 245(1): 10–17
title:Early Endoscopic Intervention Versus Early Conservative Management in Patients With Acute Gallstone Pancreatitis and Biliopancreatic Obstruction: A Randomized Clinical Trial
Objective:
To test the hypothesis that early endoscopic intervention, performed on patients with acute gallstone pancreatitis and biliopancreatic obstruction, reduces systemic and local inflammation.
Summary Background Data:
The role of early endoscopic intervention, in the treatment of acute gallstone pancreatitis, remains controversial. Previous randomized trials have not focused on the subgroup of patients with clinical evidence of biliopancreatic obstruction.
Methods:
This single-center randomized clinical trial was performed between May 2000 and September 2005. Of 238 patients, admitted within 48 hours after the onset of acute gallstone pancreatitis, 103 with a distal bile duct measuring ≥8 mm combined with a total serum bilirubin ≥1.20 mg/dL, were randomized to receive either endoscopic retrograde cholangiopancreatography followed by endoscopic papillotomy for bile duct stones (EEI, n = 51) or early conservative management (ECM, n = 52). Patients with clinical evidence of coexisting acute cholangitis were excluded. Outcome measures included changes in organ failure score and computed tomography (CT) severity index during the first week after admission, incidence of local complications, and overall morbidity and mortality.
Results:
The incidence of bile duct stones at EEI was 72% and 40% of patients in the ECM group had persisting bile duct stones at elective biliary surgery. No significant differences were found between the EEI and ECM groups regarding changes in mean organ failure score (P = 0.87), mean CT severity index (P = 0.88), incidence of local complications (6% vs. 6%, P = 0.99), overall morbidity (21% vs. 18%, P = 0.80), and mortality (6% vs. 2%, P = 1).
Conclusions:
The present study failed to provide evidence that early endoscopic intervention reduces systemic and local inflammation in patients with acute gallstone pancreatitis and biliopancreatic obstruction. If acute cholangitis can be safely excluded, early endoscopic intervention is not mandatory and should not be considered a standard indication. 翻译得不好，请大家多指正。谢谢
Objective:
To test the hypothesis that early endoscopic intervention, performed on patients with acute gallstone pancreatitis and biliopancreatic obstruction, reduces systemic and local inflammation. 为了验证在急性胆原性胰腺炎和胆胰梗阻的病人中早期行内镜介入是否能减轻全身及局部的炎症。
Summary Background Data:
The role of early endoscopic intervention, in the treatment of acute gallstone pancreatitis, remains controversial. Previous randomized trials have not focused on the subgroup of patients with clinical evidence of biliopancreatic obstruction. 对于急性胆原性胰腺炎的治疗，早期内镜介入目前还有争议。以前的随即试验并没有特别关注到有临床证据的胆胰梗阻病人。
Methods:
This single-center randomized clinical trial was performed between May 2000 and September 2005. Of 238 patients, admitted within 48 hours after the onset of acute gallstone pancreatitis, 103 with a distal bile duct measuring ≥8 mm combined with a total serum bilirubin ≥1.20 mg/dL, were randomized to receive either endoscopic retrograde cholangiopancreatography followed by endoscopic papillotomy for bile duct stones (EEI, n = 51) or early conservative management (ECM, n = 52). Patients with clinical evidence of coexisting acute cholangitis were excluded. Outcome measures included changes in organ failure score and computed tomography (CT) severity index during the first week after admission, incidence of local complications, and overall morbidity and mortality. 这个单中心的随即临床试验是在2000年5月到2005年九月开展的。5年间总共有238个病人在急性胆原性胰腺炎发作后的48小时内入院，其中有103名患者胆总管扩张》8MM，且血清总胆红素升高》1.20 mg/dL，这103人被随即分成两组，一组在逆行胰胆管造影后行内镜下乳头切开取石（EEI,N=51），另一组早期保守治疗（ECM,N=52）。合并了急性胆管炎的病人未入选。预后的评价包括器官衰竭评分的变化，入院第一周的CT严重指数，局部并发症的发生，及总的发病率死亡率。
Results:
The incidence of bile duct stones at EEI was 72% and 40% of patients in the ECM group had persisting bile duct stones at elective biliary surgery. No significant differences were found between the EEI and ECM groups regarding changes in mean organ failure score (P = 0.87), mean CT severity index (P = 0.88), incidence of local complications (6% vs. 6%, P = 0.99), overall morbidity (21% vs. 18%, P = 0.80), and mortality (6% vs. 2%, P = 1). 胆总管结石的发病率在EEI组为72%，在ECM组中有40%的病人通过择期手术发现有胆总管结石。在平均器官衰竭评分，CT严重指数，局部并发症的发病率，总体发病率，死亡率方面，EEI和ECM组没有明显的差异。
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作者:admin@医学,生命科学 2011-03-26 17:11
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