背景：急性膽石性胰臟炎（ABP）是成人急性胰臟炎（AP）最常見的病因（38％）。它也比酒精誘導的AP花費更多醫療資源。 研究顯示ERCP加上EST能有效治療總膽管結石(CBDS)阻塞造成的ABP患者。EPBD在ABP治療中的作用尚未闡明。
目標：研究內視鏡 (EST和EPBD) 對ABP治療的成果和費用。
方法：本研究分為二大部分: 首先，研究一，我們嘗試比較台灣南部最大的醫學中心之一的ABP病患中EST / EPBD和保守治療的成果和費用。其次，研究二係透過台灣人口的回顧性之世代研究，探討不同治療（內視鏡治療包括EST、EPBD和保守療法）方法對ABP患者的影響，並強調其醫療資源消耗和醫療照護結果。
結果：在研究一中，我們證明無論胰臟炎的嚴重程度如何，EST和EPBD對高度懷疑結石的ABP患者都是高度安全和可行的。此外，與保守治療相比，EPBD可顯著縮短住院天數。在研究二中，通過使用國家健康保險資料庫，比起保守治療，
內視鏡治療傾向於降低ABP的膽囊炎，膽管阻塞，出血和死亡風險。
結論：EST和EPBD可被認為是ABP潛在的有效治療方法，儘管需要進行更大規模的前瞻性臨床試驗才能實現這一目標。.

Background: ABP is the most common etiology (38 %) of AP in adults. It was also more costly than alcohol induced AP. ERCP with EST was effective in treating ABP patients with signs of obstruction by CBD stones. The role of EPBD in the treatment of ABP has not been clarified. Aims: To study the outcomes and costs of EST/EPBD for ABP. Methods: Firstly, we try to compare the effects of EST/EPBD and conservative treatment in ABP regarding to one of the medical centers in Taiwan. Next, we explore the influences of different treatment (endoscopic vs. conservative) methods on ABP patients by a retrospective cohort study based on the Taiwan population. Results: In study one, both EST and EPBD are safe and feasible in treating ABP patients with high degree of suspicious of stones, regardless of the severity of pancreatitis. Besides, EPBD can significantly shorten the hospital days in comparing with that of the conservative treatment. In study two, by using a National Health Insurance Database, endoscopic treatments showed a tendency to reduce the risks of cholecystitis, bile duct obstruction, bleeding and death. Conclusions: EST/EPBD can be considered as a potentially effective treatment for ABP, although more large-scale prospective clinical trials are needed to clarify this goal.

論文審定書……………………………………………………………………………………….. 2
誌謝…………………………………………………………………………………………………… 3
中文摘要………………………………………………………….….. ………………………….. 4
英文摘要………………………………………..……………………. ………………………….. 5
目錄…………………………………………………………………………………… 6
LIST OF TABLES & FIGURES ………………………………………………………… 8
CHAPTER 1:
Introduction and aims of study……………………………………………………………. 9
GLOSSARY:……………………………………………………………………………………. 16
A. Endoscopic treatment of acute gallstone/biliary pancreatitis
B. Conservative treatment of acute gallstone/biliary pancreatitis
CHAPTER 2: Literature Review………………………………………………………. 18
A. Epidemiology of acute pancreatitis
B. Endoscopic treatment of acute biliary pancreatitis
C. Outcomes of Endoscopic treatment of acute biliary pancreatitis
D. National health insurance system of Taiwan and the expected health expenditures in treating patients with ABP
CHAPTER 3: Conceptual framework……………………………………………. 28
HYPOTHESIS 1……………………………………………………………………………. 32
HYPOTHESIS 2
STUDY ONE……………………………………….. ……………………………………… 33
EST and EPBD are safe and effective in the treatment of acute biliary pancreatitis with high degree of suspicion of bile duct stones
Research Design
Participants
Endoscopic Procedures
Dependent variables
Independent variables
Ethical Consideration
Statistical Analysis
Results
Discussion
STUDY TWO------------------------------------------------------------------ 46
Analysis of the therapeutic effects of endoscopic and conservative treatment for acute biliary pancreatitis: A retrospective cohort study based on Taiwan population.
Research Design
Dependent variables
Independent variables
Ethical Consideration
Statistical Analysis
Results
Discussion

CONCLUSIONS------------------------------------------------------------------57

REFERENCES-----------------------------------------------------------------58

FIGURES AND LEGENDS--------------------------------------------------67

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