作者：李能平 陆仁达 周鸣清
【摘要】 目的 探讨急性胆石性胰腺炎复发的预防方法。方法 对1999年1月～2001年7月连续入院并治愈的112例急性胆石性胰腺炎患者的临床资料进行分析、随访。所有患者入院前均无胆石性胰腺炎病史且未行胆囊切除术。根据患者住院期间是否行内镜下Oddi括约肌切开术(endoscopic phincterotomy，简称EST)，将所有患者分为EST组和非EST组，并根据是否行胆囊切除术进一步分组，比较各组胆石性胰腺炎复发率。结果 平均随访18.5个月(6～30个月)。EST组38例，其中16例行胆囊切除术，均无胆石性胰腺炎复发(0/38)；非EST组74例，14例胆石性胰腺炎复发(14/74)，复发率为189%，两组差异有显著性(P＜0.01)。在非EST组中，胆囊切除29例，2例胆石性胰腺炎复发(2/29)，复发率为6.9%；未作胆囊切除45例，12例胆石性胰腺炎复发(12/45)，复发率为26.7%，胆囊切除后胆石性胰腺炎复发率显著降低(P＜005)。复发距患者出院时间为2周～2年不等。对2例胆囊切除术后复发的胆石性胰腺炎患者行ERCP，均发现有胆总管结石，行EST后，无胰腺炎发作。结论 EST能有效预防胆石性胰腺炎复发，并具有创伤小、恢复快等优点，适合于高龄、一般情况差、不能耐受手术的患者；胆囊切除能降低胆石性胰腺炎复发率，胆总管结石是胆囊切除术后胆石性胰腺炎复发的主要原因。
【关键词】 内镜下Oddi括约肌切开 胆石性胰腺炎 复发
Clinical methods of preventing the recurrence of acute gallstone pancreatitis
【Abstract】 Objective To explore the clinical methods of preventing the recurrence of acute gallstone pancreatitis.Methods From January 1999 to July 2001，the clinical data of 112 consecutive cases of cured acute gallstone pancreatitis were analyzed and followed.Before admission all patients had no gallstone pancreatitis and cholecystectomy.All cases were divided into EST group or non-EST group according to whether EST (endoscopic sphincterotomy) was performed or not.The incidence of recurrent pancreatitis in each group was compared.Results Median follow-up after discharge was 18.5 (range，6 to 30) months.None had recurrent pancreatitis in all 38 cases of EST group (0/38)，including 16 cases underwent cholecystectomy，14 had recurrent pancreatitis in all 74 cases of non-EST group (14/74)，the recurrence rate was 18.9% (P＜0.01).In non-EST group，45 cases didnt undergo cholecystectomy (intact gallbladder)，12 had recurrent gallstone pancreatitis (12/45)，the recurrence rate was 26.7%，29 cases underwent cholecystectomy，2 had recurrent gallstone pancreatitis (2/29)，the recurrence rate was 6.9%.The recurrence rate was significantly reduced after cholecystectomy (P＜0.05).The duration from patients discharge to recurrence was 2 weeks to 2 years.2 recurrent gallstone pancreatitis cases who had undergone cholecystectomy were performed ERCP and EST，common bile duct calculi were found in all 2 cases，after EST，no symptoms of pancreatitis appeared.Conclusion EST is an effective and alternative method for preventing the recurrence of gallstone pancreatitis，and it is suitable for aged high-risk patients because of its minimally invasiveness.Cholecystectomy can reduce the recurrence rate of gallstone pancreatitis，common bile duct calculi are the major cause of recurrent gallstone pancreatitis.
【Key words】 endoscopic sphincterotomy gallstone pancreatitis recurrence
急性胆石性胰腺炎是胆道结石的一个严重并发症，具有较高的病死率，并且常常反复发作。为防止胆石性胰腺炎复发，通常采取胆囊切除术。近年来，国外有文献报道可应用内镜下Oddi括约肌切开术(EST)来防止胆石性胰腺炎复发［1，2］，本文分析比较EST、胆囊切除术对预防胆石性胰腺炎复发的临床效果，旨在探讨防止胆石性胰腺炎复发的方法。
1 资料与方法
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