2023膽源性胰腺炎內(nèi)鏡治療現(xiàn)狀和發(fā)展趨勢(shì)

的30%~70%,其中嚴(yán)重并發(fā)癥發(fā)生率為20%～40%[1-2]。ABP的是微結(jié)石(直徑<5mm)是ABP的主要誘因[5]。膽道微小結(jié)石通過(guò)(endoscopicultrasound,EUS)或磁共振胰膽管成像(magnetic除梗阻狀態(tài)[6]。除針對(duì)ABP病因治療之外，內(nèi)鏡技術(shù)還在ABP相關(guān)并進(jìn)行檢查[13]。用[14-15]。近年有報(bào)道稱(chēng)，EUS在預(yù)測(cè)ABP嚴(yán)重程度方面具有價(jià)值，度為84.2%,陽(yáng)性預(yù)測(cè)值為88.9%,陰性預(yù)測(cè)值為91.2%,同時(shí)SI在區(qū)分輕型和重型AP的準(zhǔn)確率為87.9%,能夠準(zhǔn)確預(yù)測(cè)90%AP病人的嚴(yán)重炎行ERCP的最佳時(shí)機(jī),僅有研究提出ERCP可在病人入院24~72h開(kāi)展診科20h,發(fā)生癥狀29h[32-33]。內(nèi)鏡下取石術(shù)(endoscopiclithotomy,EL)等技術(shù)[38-39]。ERCP可使并發(fā)癥發(fā)生率降低至10%[41-42]。EST治療ABP的機(jī)制可能是釋vanSantvoort等[44]的隨機(jī)對(duì)照研究結(jié)果顯示，胰腺壞死治療目前遵乳頭引流。在ABP發(fā)病后12~14d,應(yīng)該避免使用介入性治療手段，引4內(nèi)鏡在預(yù)防ABP復(fù)發(fā)中的作用癥的發(fā)生率[16,61]。針對(duì)LC的治療時(shí)機(jī)，美國(guó)消化病學(xué)會(huì)和美國(guó)消[65]。另外有研究顯示，在初發(fā)ABP的病人中2年內(nèi)仍未接受LC的病人占24.7%[66]。研究報(bào)道顯示，如果不接受手術(shù)治療，在隨訪12~14個(gè)月期間，ABP的復(fù)發(fā)率預(yù)估為12%~15%[67-68]。5內(nèi)鏡在ABP腸內(nèi)營(yíng)養(yǎng)中的作用pancreatitisintheeraofendoscopicuoutcomeonadmission[J].Pancreas,2018,47(4):454-458.pancreatitis:Aprospectivepilotstudy[J].WorldJGastmanagementofacutepangallstonepancreatitis[J].BrJSu[18]PetrovM,UcEndosc,2008,22(11):2338systematicreview[J].Pancreas,2013,42(5):774-780.[21]WorkingPartyoftheBritiandIreland.UKguidelinesforthem[23]CrockettS,WInitialManagementofAcutePancreatitischolecystectomyonlateoutcomeaftergallstonepancreatitis[J].BrJSurgductstones(CBDS)[J].Gut,2017,66(5):765cholangiopancreatographywithspgallstonepancreatitis(APEC);:amulticent396(10245):167-176.NEnglJMed,1993,328(4):228-232.cholangiopancreatographyandendoscopicsphinpancreatitisduetogallstones[J].Lclinicaltrial[J].AnnSurg,2015(2):CD010339.biliarypancreatitis[J].Sursystematicsurveyofprospectivestudies[J].AmJGastroenterol,2007,102(8):1781-cholecystectomy[J].DigLiverDis,2019,51(11):1567-1573.necrotizingpancreatitis[J].NEngl]Med,201Surg,2017,83(2):316-327.391(10115):51-58.evidence?[J]JAmCollSurg,2009,209(3AmJMed,2019,132(7):e620.[49]AkshintalaV,SaxenaP,ZaheerA,etal.AcpercutaneousdrainageforsymptomaticpancreaticpseudocysGastroenterology,1996,111(3):755-764.ManagementofPancreaticNecrosis[J]stentsfordrainageofwalled-offnecrosisinarandomisedofpancreaticfluidcollectionsandtheirmanagement[J].AnnGastroenterol,2019,32(5):441-peripancreaticnecrosis[J].Lancet(London,England),2000,356(92multicenterUnitedStatestrial[J].EndoscUlpancreatitiswhosecholecystbiliarypancreatitis[J].Gastroi[61]daCostaD,Dilaparoscopicbiliarytract[J].GastrointestEndosc,2015,82(2):203-214.[65]NguyenG,Tuskeforacutegallstonepancreatitis:anationalsurvey[J].AmJGastroe