早期内镜下乳头括约肌切开术治疗老年急性胆源性胰腺炎的疗效

The Curative Effect of Early Endoscopic Sphincterotomy for the Treatment of Elderly Acute Biliary Pancreatitis

摘要: 目的：探讨早期内镜下乳头括约肌切开术(EST)治疗老年急性胆源性胰腺炎的疗效。方法：回顾性选取本院在2021年1月至2023年1月收治的556例老年急性胆源性胰腺炎患者，根据治疗方式的不同分为两组，对照组(289例)予以常规保守治疗，观察组(267例)行早期EST治疗。观察两组治疗前后的炎症因子水平、肝功能指标、临床症状变化，对比两组的治疗效果及并发症发生情况。结果：相比治疗前，两组治疗后的CRP、TNF-α、IL-6、WBC、D-D及AMY水平均明显下降，ALT、AST、TBIL及GGT水平均有所提高(P < 0.05)，并且观察组治疗后的CRP、TNF-α、IL-6、WBC、D-D、AMY、ALT、AST、TBIL及GGT水平均低于对照组(P < 0.05)。观察组的AMY、WBC、TBIL恢复正常时间均比对照组更短(P < 0.05)。观察组的腹痛缓解时间、体温恢复正常时间、住院天数均比对照组更短，治疗费用比对照组更高(P < 0.05)。观察组的并发症总发生率明显低于对照组(1.20% vs 5.60%, P < 0.05)；两组的病死率接近(P > 0.05)。结论：早期EST治疗老年急性胆源性胰腺炎能有效控制炎症反应，缓解临床症状，其疗效显著，且对患者肝功能有一定的作用，并发症发生率低。

Abstract: Objective: To explore the efficacy of early endoscopic sphincterotomy (EST) in the treatment of el-derly acute biliary pancreatitis. Method: A retrospective selection was conducted on 556 elderly patients with acute biliary pancreatitis admitted to our hospital from January 2021 to January 2023. They were divided into two groups based on different treatment methods. The control group (289 cases) received routine conservative treatment, while the observation group (267 cases) received early EST treatment. The levels of inflammatory factors, liver function indicators, and clinical symptoms were compared before and after treatment in two groups, and the treatment effects and incidence of complications were compared between the two groups. Result: Compared to before treatment, the levels of CRP, TNF-α, IL-6, WBC, D-D, and AMY were significantly reduced, while the levels of ALT, AST, TBIL, and GGT were all increased (P < 0.05), and the levels of CRP, TNF-α, IL-6, WBC, D-D, AMY in the observation group after treatment were also significantly reduced, and the levels of ALT, AST, TBIL, and GGT were all lower than those of the control group (P < 0.05). The re-covery time of AMY, WBC, and TBIL in the observation group was shorter than that in the control group (P < 0.05). The observation group had shorter relief time for abdominal pain, recovery time for body temperature, and length of hospital stay compared to the control group, and higher treat-ment costs (P < 0.05). The total incidence of complications in the observation group was significant-ly lower than that in the control group (1.20% vs 5.60%, P < 0.05). The mortality rates of the two groups were close (P > 0.05). Conclusion: Early EST treatment for elderly acute biliary pancreatitis can effectively control inflammatory response, alleviate clinical symptoms, and has a significant therapeutic effect. It also has a certain effect on liver function in patients, with a low incidence of complications.