| Acute biliary pancreatitis(ABP)is a common disease of the digestive system,and has a benign clinical course and most patients with AP experience a mild case.However some patients develop severe acute pancreatitis(SAP),which is associated with local or systemic complications and a high risk of mortality.For ABP,treatment involves multiple approaches,such as conservative treatment,minimally invasive endoscopic treatment,or surgical treatment,and the multiple approaches combined or multidisciplinary treatment is usually adopted clinically.With the development of ERCP,it has become the optimal method for the treatment of ABP.However,ERCP is an invasive operation,there are many risks such as postoperative bleeding,infection,and increased pancreatitis,therefore how to operate it safely and effectively is crucial.Objective:The aim of this study was to compare and analyse the differences in laboratory indicators,clinical symptom remission and complications incidence caused by different treatment methods and emergency ERCP procedures in patients with biliary pancreatitis in our hospital and to identify the best operation procedure.Methods:Retrospective analysis of acute biliary pancreatitis in my hospital since January 1,2015 solstice,June 30,2020.There were 168 patients.According to the different treatment methods divided into group N(conservative treatment group with 38 cases)and group E(emergency ERCP treatment group with 130 cases).And then,according to the different operation procedures divided the patients who were in group E into 3 groups: group E1(The procedure was that the guidewire was preferentially entered into pancreatic duct and the bile duct was intubated successfully)with 44 cases,group E2(The procedure was that the guidewire was preferentially entered into bile duct,and no pancreatic duct intubation)with 46 cases and group E3(The procedure was that the guidewire was preferentially entered into bile duct,and then the pancreatic duct was intubated unsuccessfully)with 40cases.Analysis was made in basic information,the days of hospitalization,the hospitalization expense,the recovery time of abdominal pain,intestinal exhaust time,the recovery time of normal diet,the recovery time of white blood cells to normal level,the recovery time of serum amylase to normal level,preoperative laboratory indicators and postoperative laboratory indicators of emergency ERCP,was given a statistical disposition by SPSS26.0 software.Results:1.The general information There were no significant differences in age,sex,preoperative scores and the ratio of patient’s condition severity among the four groups(P>0.05).2.Clinicl symptoms The recovery time of abdominal pain,the recovery time of white blood cells to normal level,the recovery time of serum amylase to normal level in group E1、E2 were shorter than group N(P<0.05).The recovery time of normal diet in group E1 was shorter than group N(P=0.01).The days of hospitalization in group E2 was shorter than group N(P=0.04).The intestinal exhaust time in group E1、E2、E3 was shorter than group N(P<0.05).However,in terms of the single hospitalization expense,group N was less than the other three groups,and the difference was statistically significant(P<0.001).3.Laboratory results Compared with the three groups,there were no significant differences in all laboratory results before the operation(P>0.05).The comparison of laboratory results and scores after the operation occurred among the three groups :In E1 group,the levels of AMY at postoperative 6hours,APACHE Ⅱ,ALT,GGT,LDH and TB at postoperative 48 hours had been reduced,the differences had statistical significance(P<0.05).In E2group,the levels of AMY at postoperative 6 hours,APACHEⅡ,ALT,GGT and TB at postoperative 48 hours had been reduced,the differences had statistical significance(P<0.05),but postoperative LDH had not reduced significantly compared with preoperative LDH(P=0.82).In E3 group,the levels of AMY at postoperative 6 hours,APACHEⅡ,ALT,and GGT at postoperative 48 hours had been reduced,the differences had statistical significance(P<0.05),but postoperative LDH and TB had not reduced significantly compared with preoperative LDH and TB(P=0.76,P=0.08).The comparisons occurrd about the difference of the laboratory data among three groups: The decrease degree of GGT,LDH and TB at postoperative 48 hours had no significant differences(P>0.05).The comparison had been conducted for P value under 0.05,the difference of APACHE Ⅱ at postoperative 48 hours: group E1 was higher than group E2(P=0.02).The difference of AMY at postoperative 6 hours: group E1 was higher than group E3(P=0.01).The difference of ALT at postoperative 48 hours : group E1 and group E2 were higher than group E3(P<0.05).The comparison of complication among three groups had no statistical significance(P=0.40).4.According to the severity of the pancreatitis,the patients were divided into mild group and non-mild group,and then we set up a subgroup analysis to compare all data in the two groups.(1)In the mild group,in terms of hospitalization expenses,E2 group was less than E1 group(P<0.001).In E1 and E2 group,the levels of AMY at postoperative 6 hours,APACHE Ⅱ,ALT,GGT,and TB at postoperative 48 hours had been reduced(P<0.05),and postoperative LDH had not reduced significantly compared with preoperative LDH(P=0.47,P=0.34).In E3 group,the levels of AMY at postoperative 6 hours,APACHE Ⅱ,ALT and GGT after the operation had been reduced(P<0.05),and postoperative LDH and TB had not reduced significantly compared with preoperative LDH and TB(P=0.88,P=0.75).The comparison had been conducted for P value under 0.05,the difference of AMY at postoperative 6 hours: group E1 was higher than group E3(P=0.01).The difference of ALT 48 hours after the operation: group E2 was higher than group E3(P<0.001).The comparison of complications among three groups had no statistical significance(P=0.93).(2)In the non-mild group,there were no significant differences in general information among the three groups(P>0.05).In terms of the days of hospitalization,E1 group and E2 group were less than E3 group(P<0.01).In E1 group,the levels of AMY at postoperative 6 hours,APACHE Ⅱ,LDH and TB 48 hours after the operation had been reduced,the differences had statistical significance(P<0.05),and postoperative ALT and GGT had not reduced significantly compared with preoperative ALT and GGT(P=0.06,P=0.06).In E2 group,the levels of AMY at postoperative 6 hours,APACHEⅡ,ALT,GGT,and TB after the operation had been reduced,the differences had statistical significance(P<0.05),and postoperative LDH had not reduced significantly compared with preoperative LDH(P=0.25).In E3 group,the levels of APACHE Ⅱ,ALT,GGT and TB at postoperative 48 hours had been reduced(P<0.05),and the level of AMY and LDH had not reduced significantly compared with preoperative level(P=0.25,P=0.35).The comparison had been conducted for P value under 0.05,the difference of AMY 6 hours after the operation: group E1 and group E2 were higher than group E3(P<0.05).The difference of LDH 48 hours after the operation: group E1 was higher than group E2 and group E3(P<0.05).The difference of ALT 48 hours after the operation: group E2 was higher than group E3(P<0.05).In terms of complication,group E1 had 4 cases(the rate of complication was 25.00%),group E2 had 7 cases(the rate of complication was 29.17%),group E3 had 10 cases(the rate of complication was 76.90%),group E1 and group E2 were lower than group E3,the differences had statistical significance(P<0.0167).Conclusion:1.For the patients with ABP,emergency ERCP has some advantages in clinical symptom relief,hospitalization days and inflammatory index recovery compared with conservative treatment.However,the cost of single hospitalization in conservative treatment group is lower than operation group,so comprehensive evaluation should be made according to patients’ condition and economic conditions,and individualized treatment plan should be adopted.2.For patients with ABP,temporary pancreatic stents combined with endoscopic nasobiliary drainage during emergency ERCP is beneficial to postoperative recovery and reduce related complications.For mild patients,the therapeutic effects of different procedures of emergency ERCP,under the principle of minimum injury are similar,and the appropriate scheme can be chosen according to the actual situation of the patients.3.For patients with non-mild ABP,if the guide wire is given priority to enter the pancreatic duct during emergency ERCP,after the successful intubation of the bile duct,the pancreatic duct stent is placed directly after the papillary sphincterotomy and then nasobiliary drainage is performed.If the guide wire enters the bile duct first,the sphincterotomy and nasobiliary drainage can be performed directly,and minimizing the stimulation of the pancreatic duct is beneficial to reduce the occurrence of complications. |
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