A Retrospective Analysis Of Therapeutic Results In 159 Acute Biliary Pancreatitis Cases

Objective To assess the therapeutic results of acute biliary pancreatitis and optimize the therapeutic strategy of acute biliary pancreatitis.Methods The clinical data were collected from 159 patients with acute biliary pancreatitis in 2nd Hospital Shanxi Medical University from April 2005 to September 2010. The cases were divided into four types according to severity of disease and bile duct obstruction , the cases of mild cases without bile duct obstruction,mild cases with bile duct obstruction,severe cases without bile duct obstruction,and the severe cases with bile duct obstruction were 68, 43, 27, 21 respectively. All cases received conservative treatment as soon as admission,in which 64 cases with bile duct obstruction were divided into endoscopic therapy group and open surgery group according to different modus operandi. The index of the time to ease abdominal pain, hours of serum amylase returned to normal level,days of hospital stay,recovery rate,incidence of complication and fatality rate in four groups with different therapeutic protocol were analyzed. Results 95 cases without bile duct obstruction improved after receiving conservative treatment, in which there were no significant difference of the time to ease abdominal pain(2.761.68), hours of serum amylase returned to normal level(3.42±1.37),days of hospital stay (10.643.84),recovery rate(100%),incidence of complication(0)and fatality rate(0) between the mild cases and the severe cases (P>0.05). Of the 64 cases with bile duct obstruction were treated with surgery operation after admission to hospotial.There were significant improvement of the time to ease abdominal pain(6.25 3.91), hours of serum amylase returned to normal level(6.12 2.86),days of hospital stay(16.43 4.18) of mild case in the endoscopic therapy group in comparison with the open surgery group, the former shorts of the latter (P<0.05). There were no significant difference of recovery rate(100%), incidence of complication(11.8%) and fatality rate(0)of mild case in the endoscopic therapy group in comparison with the open surgery group (P>0.05). There were significant improvement of the time to ease abdominal pain(13.47 3.26), hours of serum amylase returned to normal level(12.35 3.64),days of hospital stay(21.68 5.35), recovery rate(66.7%)of severe case in the endoscopic therapy group in comparison with the open surgery group, the former shorts of the latter (P<0.05). There were no significant difference of incidence of complication(22.2%)and fatality rate(33.3%)of severe case in the endoscopic therapy group in comparison with the open surgery group (P>0.05).Conclusion The treatment of acute biliary pancreatitis should be done according to the type. The non-operation protocol was effective for mild cases without bile duct obstruction ;for the cases with bile duct obstruction, conservative treatment should be followed by either endoscopic drainage treatment or open surgery , while endoscopic drainage should be preferred based its mini-invasive advantage.