鼻胆管引流术预防内镜逆行胰胆管造影术后胰腺炎及高淀粉酶血症的临床观察

目的 探讨鼻胆引流术（ENBD）预防内镜逆行胰胆管造影术（ERCP）后胰腺炎及高淀粉酶血症的效果.方法 收集诊断性及治疗性ERCP患者119例,其中68例患者术后放置鼻胆引流管,与51例术后未放置鼻胆引流管患者（对照组）比较,观察术后2小时和24小时血清淀粉酶值,比较两组术后高淀粉酶血症及胰腺炎的发生.结果 两组患者均操作成功.ENBD组术后2小时及24小时血清淀粉酶分别为（234.72 ＋82.16） U/L和（288.92±74.34） U/L,与对照组术后2小时及24小时血清淀粉酶[（547.13±121.27） U/L和（581.92±102.13） U/L]比较,差异有统计学意义（P＜0.05）.ENBD组与对照组分别有8例（11.8％）和22例（43.1％）发生高淀粉酶血症,两组比较差异有统计学意义（P＜0.05）；两组分别有1例（1.5％）和9例（17.6％）发生术后胰腺炎,两组比较差异有统计学意义（P＜0.05）.两组患者均未见重症胰腺炎发生.结论 内镜下放置鼻胆引流管能有效预防ERCP术后胰腺炎及高淀粉酶血症,方法简单,值得临床推广.

Prevention of ENBD on post-ERCP pancreatitis and hyperamylasemia

Objective To investigate the value of endoscopic nasobiliary drainage （ENBD） in the prevention of post-endoscopic retrograde cholangiopancreatography （（ERCP） pancreatitis and hyperamylasemia. Methods A total of 119 cases were enrolled in the study,and derided into 68 cases with ENBD（ ENBD group） and 51 cases with routine treatment（ control group）. The amylase levels were measured after ERCP 2 and 24h. Meanwhile, the occurrence of pancreatitis and hyperamylasemia after ERCP was also evaluated. Results All cases were operated successfully. The 2h and 24 h serum amylase were （234.72 ± 82.16）U/L and （288.92 ±74.34）U/L in the ENBD group vs. （547.13 ±121.27 ）U/L and （581.92 ±102.13 ）U/L in control group. There were significant differences between these two groups （P 〈 0.05 ）. 8 cases in ENBD group（ 11.8% ） and 22 cases in the control group （43.1% ） had hyperamylasemia after ERCP（ P 〈 0.05 ）. 1 case in ENBD group （ 1.5% ） and 9 cases in control group （ 17.6% ） bad panereatitis. The difference between these two groups was significant （ P 〈 0.05 ）. Severe pancreatitis cases was not observed in these two groups. Conclusions ENBD can effectively prevent the occurrence of post-ERCP pancreatitis and hyperamylasemia, and is worthy of application in clinical practice.