Treatment Of Acute Biliary Pancreatitis By Integrated Medical Method

ObjectiveTo evaluate the clinical effect of mini-invasive treatment of integrated Traditional and Western Medicine for acute biliary pancreatitis(ABP), and observe the effect of the Chinese medicine "Qing Yi Soup" enhanced by Huo Xue Hua Yu drug. To approach the essentiality of emergent endoscope procedures for ABP found, by imaging examination with choledochectasia only, and analyze the treatment mode and high risk factors which can induce post-endoscopic pancreatitis . Methods94 patients indentified with ABP from January 2004 to December 2005 were studied. All of them presented with Acute Cholangitis or Calculus of bile duct ,and were randomly divided into three groups: the control group , the "Qing Yi Soup" group and the "Huo Xue Qing Yi Soup" group. The level of UAMY. TBIL, ALT. ALP were monitored during treatment, meanwhile the pancreas edema and fluidify around pancreas were observed intimately. 68 patients with ABP which presented with simple choledochectasia were randomly divided into the control group and the emergent endoscopic group,and observed the clinical symptom, urinary amylase, the turnover of pancreas edema and fluidify around pancreas .Then 2149 patients with ERCP from January 2004 to December 2005 were studied prospectively to detect the relation between PEP and the treatment mode or possible risk factors. Result94 patiants with ABP which presented with Acute Cholangitis or Calculus of bile duct underwent emergent endoscope procedures, and 91 cases were successful without severe complications or mortality. All of the patients had ENBD with stone incarcerate in duodenal ampulla (19 cases) and precut (24 cases). Compared with the control group, the duration of symptoms and the levels of urinary amylase , TBIL, ALT, ALP inChinese medicine group were decreased significantly. The "Qing Yi Soup" group and the "Qing Yi Soup" with the effect of Huo XueHua Yu drug group also was significant in some indexes. Statistically significant differences were also found in 62 patients with ABP which presented with simple choledochectasia. In addition ,we found that the independent risk factors to PEP including inserting pancreatic duct catheter deeply, pancreatic duct dysfunction, pancreatitis history, sphincter dysfunction, pancreatography with contrast medium and times of pancreatography. The electric current of EST might have relation to PEP and hyperamylasemia. ConclusionAcute biliary pancreatitis with Biliary Obstruction can be managed safely and effectively with a combined the traditional Chinese medicine and endoscope procedure. It took a good advantage of the integration traditional and western medicine;and perhaps provided an ideal method for ABP at present. Our experience also proposed a systemic scheme of acute biliary pancreatitis initially. In addition, we had determined the high risk factors and treatment mode inducing PEP easily.