Analysis of operation timing and clinical efficacy of endoscopic retrograde cholangiopancreatography in the treatment of acute biliary pancreatitis / 国际外科学杂志

ABSTRACT

Objective To discuss the operation timing,clinical efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of acute biliary pancreatitis.Methods Retrospective analyzed the clinical data of 65 acute biliary pancreatitis patients in First People's Hospital of Jiangxia District,Wuhan city form October 2015 to July 2017,there were 45 males and 30 females,the age was (46.35 ± 8.95) years (range,25-72 years).All patients were treated with ERCP,and divided into 24-72 h group (the time from onset to ERCP treatment 24-72 h) 16 cases,72-120 h group (the time from onset to ERCP treatment 72-120 h) 25 cases and ≥ 120 h group(the time from onset to ERCP treatment ≥ 120 h) 34 cases,recorded and compared the clinical indexes during and after operation,laboratory indexes before and after treatment,incidence of surgical complications,recurrence rate and mortality.The measurement data with normal distribution were expressed as mean ± standard deviation (Mean ± SD),the F test was used for comparison among the three groups,and the t test was used for comparison between the two groups,the count data were compared by x2 test,and the rank sum test was used to compare the incidence of surgical complications.Results The abdominal pain relief time,amylase recovery time,length of stay and hospitalization expenses of the 24-72 h group were (4.48 ± 1.29) d,(3.59 ± 1.22) d,(7.24±1.55) d and (1.55 ±0.31) ten thousand yuan respectively,the 72-120 h group were (7.35 ± 1.76) d,(4.91 ±1.37) d,(13.61 ±2.13) d,(2.02 ±0.37) ten thousand yuan respectively,the ≥120 h group were (11.21 ±2.02) d,(8.86±1.95) d,(21.58±2.86) d,(2.49±0.52) ten thousand yuan respectively,with significant differences between any two groups(P ＜0.05).The serum amylase,total bilirubin,c-reactive protein and white blood cell levels of the 24-72 h group were (319.65 ±58.93) U/L,(14.22 ± 2.84) μmol/L,(31.12 ± 5.35) mg/L and (6.84 ± 1.17) × 109/L respectively,the 72-120 h group were (362.87 ±63.37) U/L,(16.39 ± 3.14) μmol/L,(37.34 ± 6.12) mg/L and (7.93 ± 1.36) x 109/L respectively,the ≥ 120 h group were (452.61 ± 75.49) U/L,(20.28 ± 3.67) μmol/L,(46.19 ± 6.98) mg/L and (9.77 ± 1.52) x 109/L respectively,with significant differences between any two groups (P ＜ 0.05).The incidence of surgical complications,recurrence rate and mortality of the 24-72 h group were 25.00％ (4/16),12.50％ (2/16) and 0 (0/16) respectively,the 72-120 h group were 24.00％ (6/25),12.00％ (3/25) and 0 (0/25) respectively,the ≥120 h group were 29.41％ (10/34),20.59％ (7/34) and 5.88％ (2/34) respectively,with significant differences between 24-72 h group,72-120 h group and ≥ 120 h group (P ＜ 0.05);But there was no significant difference between the 24-72 h group and the 72-120 h group (P ＞0.05).Conclusion In the treatment of acute biliary pancreatitis within 24-72 h and 72-120 h are safe and effective,but the improvement of laboratory indexes within 24-72 h ERCP treatment is more obvious,the length of stay is shorter,the hospitalization expenses is more provincial,and with more clinical advantage.