早期内镜逆行胰胆管造影治疗急性胆源性胰腺炎伴急性胆管炎的效果分析OA

Objective To evaluate the safety and feasibility of early endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of acute biliary pancreatitis(ABP)complicated by acute cholangitis,and to explore the optimal time window for ERCP intervention.Methods A retrospective analysis was performed on the clinical data of 83 patients with ABP complicated by acute cholangitis,who were admitted to the First People's Hospital of Wuyi County,Zhejiang Province,between January 2023 and May 2025.Based on the treatment modality,patients were divided into a control group(conservative medical treatment,n=39)and an observation group(conservative medical treatment combined with early ERCP,n=44).The observation group was further subdivided into a 0-24 h ERCP subgroup(n=23)and a 24-72 h ERCP subgroup(n=21).Clinical outcomes[time to abdominal pain relief,time to gastrointestinal function recovery(disappearance of abdominal distension,restoration of anal exhaust,initiation of oral intake),time for body temperature to normalize,total time of hospital stay,and total hospitalization costs],laboratory indicators[serum amylase(AMY),liver function indicators including total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(GGT),and inflammation indicators including white blood cell(WBC)count,C-reactive protein(CRP),and procalcitonin(PCT)],and complication rates were compared between the control and observation groups,as well as between the subgroups within the observation group.Results Compared with the control group,patients in the observation group had significantly shorter time for abdominal pain relief,disappearance of abdominal distension,restoration of anal exhaust,initiation of oral intake,normalization of body temperature,and hospital stay;they also had significantly lower APACHE Ⅱscores,although hospitalization costs were higher.The levels of AMY,liver function indicators,and inflammation indicators decreased more significantly in the observation group compared with the control group(P<0.05).Within the observation group,the 0-24 h ERCP subgroup showed significantly shorter time for abdominal pain relief,recovery of various gastrointestinal function indicators,temperature normalization,and hospital stay compared with the 24-72 h subgroup(P<0.05);however,there were no statistically significant differences in the levels of AMY,liver function indicators,or inflammation indicators between the two subgroups(P>0.05).Complications in both groups included abdominal effusion,abdominal infection,pancreatic pseudocyst,gastrointestinal bleeding,and disease aggravation.There was no statistically significant difference in the total incidence of complications between the two groups[11.36%(5/44)vs 15.38%(6/39)],nor was there a statistically significant difference between the two subgroups within the observation group[8.69%(2/23)vs 14.28%(3/21)](all P>0.05).Conclusion For patients with ABP complicated by acute cholangitis,early ERCP intervention(especially within 24 hours of admission)can safely and effectively accelerate the recovery of clinical symptoms and biochemical indicators,improve short-term prognosis,and shorten the length of hospital stay.It serves as a viable option for optimizing clinical treatment strategies.