Effect Of Early ERCP On Acute Biliary Pancreatitis

Objective:To study the early ERCP(Endoscopic retrograde cholangio-pancreatography,ERCP)for the effect of the treatment of acute gallstone pancreatitis.Methods:Retrospective analysis of acute biliary pancreatitis in my hospital since August 1,2017 solstice,August 1,2019.There were 67 male patients and 59 female patients.According to the different treatment method divided the patients into three groups,respectively for early ERCP treatment group(72 hours adept ERCP diagnosis),under the guidance of ultrasound gallbladder puncture drainage(Percutaneous transhepatic gallbladder drainage,PTGD)treatment group,laparoscopic cholecystectomy,laparoscopic cholecystectomy,LC)in treatment group.All three groups received routine medical treatment before surgery,including fasting,water deprivation,gastrointestinal decompression,nutritional support,fluid resuscitation,anti-infection,acid and enzyme suppression,and other symptomatic support treatment.Patients with severe abdominal pain were treated with analgesia,gastrointestinal decompression,vital signs detection,central venous pressure monitoring,and nutritional support.The three groups were not treated independently,and there was no universal application of the two treatment methods.Through routine postoperative blood test indexes examination,postoperative complication rate,patient satisfaction,and statistical analysis of hospital stay of patients with three different treatment methods,to explore whether early ERCP treatment has better effect and safety in the treatment of acute biliary pancreatitis compared with PTGD and LC.Results:A total of 135 patients with acute biliary pancreatitis were retrospectively included in this study,which were divided into the early ERCP treatment group(45cases),LC treatment group(45 cases)and PTGD treatment group(40 cases)according to their different treatment methods.In the observation group,whether the application of early ERCP is effective in terms of the safety of the treatment effect or not.All three groups were effective;the early ERCP treatment group is clear and effective after treatment,and the biochemical indicators before and after treatment are statistically significant(P<0.01).Compared with the other two treatment groups,the length of hospitalization was also less than that of the other two groups,as shown in table 4(P < 0.05).P < 0.01).There was no significant difference in biochemical indexes between the early ERCP treatment group and the LC treatment group(P >,0.05).At 6 hours after the operation,the levels of white blood cells,ALIT,AST and GGT decreased significantly(P < 0.05),while AMYL and ALT showed no significant difference(P > 0.05).The decrease degree of AMYL,ALIT and GGT was statistically significant 3 days after surgery(P < 0.05),while there were no statistically significant differences in white blood cells,AST and ALT(P > 0.05).Compared with the PTGD group,there was no significant difference in biochemical indexes before treatment(P >,0.05).At 6 hours after the operation,the level of white blood cells,ALIT and GGT decreased significantly(P < 0.05),while there was no significant difference in AMYL,AST and ALT(P > 0.05).The degree of AMYL and AST decreased 3 days after the operation was statistically significant(P < 0.05),while there were no statistically significant differences in white blood cells,ALIT,ALT and GGT(P > 0.05).Although laparoscopic cholecystectomy can avoid the recurrence of cholelithiasis,its operation time is long,the wound is large,the wound exposure time is long,prone to postoperative infection and other complications.Ultrasound-guided cholecystocentesis,on the contrary,mainly reduces the biochemical indicators of the patients,and cannot fundamentally cure the patients,with an increased recurrence rate.Most of the patients selected in this paper are in poor physical condition,unable to tolerate surgical treatment or whose family members refuse surgery.However,ERCP,through the mouth into the duodenal papilla,has less trauma,less risk of postoperative infection,less pain,and high patient satisfaction.Meanwhile,this kind of stone removal is relatively advanced,with a high success rate and faster postoperative recovery.After preliminary conservative treatment and surgical treatment,it was found that the early ERCP treatment group could reduce the levels of white blood cells,AMYL,ALT,AST and TBIL more quickly and effectively,so as to relieve the symptoms and inflammatory reactions of patients more quickly,with more significant effect.Conclusion:The effect of early ERCP on the treatment of acute biliary pancreatitis,the decline rate of experimental indicators,and the length of hospital stay are better than those in the traditional laparoscopic surgery group and the ultrasound-guided gallbladder puncture and drainage group.