Diagnosis And Treatment Of Acute Biliary Pancreatitis

Objectives:To summarize and analyze the diagnosis and treatment options of acute biliary pancreatitis(ABP),in order to help clinicians in the treatment of ABPMethods:Retrospectively analyzed the case data of 97 ABP patients admitted to the hospital from January 2012 to August 2019.According to the patient's condition and presence or absence of biliary obstruction,97 patients were divided into 13 cases with mild obstruction,65 cases with mild non-obstruction,7 cases with severe obstruction,and 12 cases with severe non-obstruction.All patients were admitted to the hospital to improve blood amylase,blood lipase,liver function and so on.Ninety patients were admitted to the hospital to improve abdominal ultrasound;51 patients to improve abdominal CT;80 patients to improve abdominal MRI.Among them,only 5 cases underwent ultrasound;2 cases under MRI;12 cases underwent ultrasound and CT,including 1 EUS.There were 39 cases of B-ultrasound and MRI;5 cases of CT and MRI;34 cases of B-ultrasound,CT and MRI,including 1 case of EUS.Among them,34 patients underwent B-ultrasound,CT,and MRI examinations at the same time,and analyzed the detection rates of gallstones,common bile duct stones,and common bile duct dilation.Of the 77 patients with ABP without biliary obstruction,29 patients recovered after conservative treatment with ABP.After conservative treatment,48 cases were stable,and were given endoscopic treatment(n=9),endoscopic treatment(n=17),double-lens combined treatment(n=2),open surgery(n=19),Percutaneous abscess puncture treatment(n=1).Analyze and compare the cure rate,mortality rate,recurrence rate of conservative treatment and surgical treatment and non-obstructive ABP with different surgical methods.Because the number of peri pancreatic abscess puncture group was only 1 case,no statistical significance,so it was not adopted in the analysis of data.Twenty cases of ABP with biliary obstruction were treated with endoscopic(n=10)and surgical(n=10)early relief of biliary obstruction based on conservative treatment.Compare the cure rate,mortality rate,recurrence rate,postoperative complication rate,hospitalization days and hospitalization costs in the endoscopy group and the surgery group.Statistical analysis was performed using SPSS IBM 21.0 software.Results:1.97 cases of ABP,ALT>75U/L accounted for 65 cases,serum total bilirubin>40?mol/L accounted for 46 cases,However,when there was only one increase,there were only 29 cases of elevated ALT,only 10 cases of total serum bilirubin;2.34 patients underwent B-ultrasound,CT,and MRI examinations at the same time,and analyzed the detection rates of gallstones,common bile duct stones,and common bile duct dilation.The study found that for the detection rate of gallbladder stones,B-ultrasound and MRI detection are superior to CT.There is no difference between B-ultrasound and MRI;for the detection rate of common bile duct stones,MRI is superior to B-ultrasound and CT.For biliary expansion with common bile duct stones,MRI detection rate of common bile duct stones is better than CT.3.77 cases of ABP without biliary obstruction,conservative treatment and surgical treatment have no statistical significance in cure rate,mortality,complications and recurrence time;but the recurrence rate is higher operation treatment.4.The different surgical options for non-obstructive ABP are not statistically significant in terms of cure rate,mortality rate,and recurrence rate;the endoscopic group is the best in terms of hospitalization days and hospitalization costs,and the endoscopic group is slightly inferior to the endoscopic group.The complication upper endoscopic group is better than the endoscopic group.5.20 cases of ABP with biliary obstruction,the treatment of the endoscopic group and the surgical group were not statistically significant in terms of cure rate,mortality,complication rate and recurrence rate,and the endoscopic group was significantly better in the number of hospitalization days and hospitalization costs in the surgery group.Conclusions:1.For the diagnosis of ABP,ABP should be highly suspected when two of ALT,ALP,and total serum bilirubin are elevated.B-ultrasound is the first choice for imaging examination,and MRI examination can be given priority on this basis.However,MRI can miss the diagnosis of small stones in the common bile duct.At this time,we should combine the patient's liver function and add EUS to clarify the cause and diagnosis.2.For the treatment of non-obstructive ABP,wait until the patient's condition is stable,and perform surgical treatment after about 1-2 weeks.And should be completed as much as possible in this admission,to avoid the recurrence of ABP after discharge.3.In the treatment of non-obstructive ABP,laparoscopic treatment can be given priority.4.For the treatment of obstructive ABP,biliary obstruction should be relieved in time,and ERCP+EST is preferred to relieve biliary obstruction within about 24-72 hours.