Analysis of clinical effificacy of the pancreatic duct stent for treatment of acute biliary pancreatitis / 国际外科学杂志

ABSTRACT

Objective:This study was conducted to further investigate the clinical value of ERCP plus EST and pancreatic duct (PD) stent placement in treatment of ABP.Methods:The data of 115 patients with ABP in People′s Hospital of Chongqing Banan District between February 2018 to October 2020 were retrospectively analyzed. Of the patients, 46 cases received ERCP plus EST and PD stent placement(PD stent group), and other 69 cases only received ERCP plus EST(control group), all patients received surgery within 72 h. Outcome measures: preoperative complications, APACHE II score, Glasgow score, preoperative and postoperative laboratory indicators (white blood cell, C-reactive protein, serum amylase, total bilirubin, alanine aminotransferase), postoperative complications, hospitalization time, hospitalization cost. All patients received outpatient or telephone follow-up after discharge, patients were followed up for recurrence of pancreatitis and complications, follow-up ended in June 2021. Continuous data were represented as ( ± s), and comparisons between the two groups were performed using Student′s t tests for normally distributed data with homogeneity of variance. The Mann-Whitney U test was used for nonnormally distributed data. Categorical data are expressed as rates values and were analyzed with the chi-square test or Fisher′s exact test. Results:There were no significant differences between two groups in age, complications, APACHEII score, Glasgow score, preoperative laboratory examination, postoperative CRP, total bilirubin and ALT ( P>0.05). Postoperative WBC[8.5(7.6, 10.3)]×10 9/L, serum amylase [197.5(143.0, 256.0) U/L] in the PD stent group were significantly lower than control group[9.9(8.2, 12.8) 10 9/L, 270.0(168.0, 419.0) U/L]( P<0.05). The overall incidence of complications in the PD stent group (6.5%) was significantly lower than the control group (20.3%), there were statistical differences between groups( P<0.05). Hospitalization time and hospitalization cost were not significantly different between the two groups ( P> 0.05). All patients were followed up, with an average follow-up of 16 months, all recovered well postoperatively in patients with stent group, but a patient who suffered from peripancreatic abscess with severe infection needed hospitalization again in control group, another two patients with pancreatic pseudocyst, 1 case were followed up for 3 months to gradually absorbed, and 1 case underwent another surgical treatment. Conclusion:The placement of temporary pancreatic duct stent provided adequate drainage of pancreatic fluid to reverse the course of ABP, and the complication rate was significantly lower than that of the control group, with superior clinical outcome to ABP patients treated with ERCP+ EST alone.