内镜逆行胰胆管造影术后胰腺炎的防治进展

经内窥镜逆行胰胆管造影术(ERCP)目前已广泛应用于临床。但ERCP技术属于微创,可引起出血、急性胰腺炎等并发症,ERCP术后胰腺炎(PEP)发生率高,严重时可危及患者生命。通过术前预防用药、术中放置胰管支架、鼻胆管引流等预防手段,但PEP若时有发生,这在一定程度上限制了其在临床上广泛应用,本文拟就ERCP的临床应用和对PEP的防治措施做一简要综述。     

ERCP术后胰腺炎的预防策略

经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)是胆胰疾病内镜微创诊治 的重要手段,但与其他内镜操作相比,ERCP术后相关的并发症最高。ERCP术后胰腺炎(post-ERCP pancreatitis,PEP) 是其中最常见的并发症,严重时可能危及生命。积极的早期预防可以有效降低PEP的发生率。目前,在临床上有明确 效果的措施包括术前非甾体抗炎药纳肛和预防性胰管支架置入,使用乳酸林格氏液积极的水化也是预防PEP安全有效 的方法。     

ERCP术后胰腺炎的预防

经内镜逆行胰胆管造影术(ERCP)是临床上诊治胰腺胆道疾病的重要方法之一,但实施后有诱发胰腺炎、十二指肠胰胆管及壶腹周围穿孔、出血、感染等可能.其中ERCP后胰腺炎(post-ERCP pancreatitis,PEP)是较常见的并发症,而重症胰腺炎是并发症中最严重的不良事件.当前PEP预防主要包括药物及操作技巧上的预...     

ERCP术后并发胰腺炎的高危因素分析及护理干预

目的:分析经内镜逆行胰胆管造影术(Encoscopic Retrograde Cholangio-Pancreatography,ERCP)后并发胰腺炎(pancreatic,PEP)高危因素,从而采取有效的护理干预来降低ERCP术后PEP的发生率。方法:我科于2010年5月-2013年5月,共收治胆道疾病行ERCP术者378例,进行回顾分析其高危因素。结果:其中39例已发生ERCP术后并发胰腺炎的病例,占总的行ERCP术者的13.1%,既往有胰腺炎出现ERCP术后PEP的发生率为56.8%,5例年龄80岁的患者在术后24-48h内发生了非计划性拔管并导致3例发生ERCP术后PEP。结论:根据ERCP术后PEP高危因素,术前充分评估病人,给予针对性护理干预,对治疗和预防ERCP术后PEP非常重要。     

乌司他丁预防治疗性逆行胰胆管造影术后胰腺炎的随机对照研究

<正>逆行胰胆管造影(ERCP)是目前诊断胰胆疾病的主要手段之一,该技术是一种较安全有效的检查方法,但也可出现各类并发症,特别是术后急性胰腺炎(PEP)及高淀粉酶血症[1],严重者可危及生命,而预防并发症是保证ERCP术成功的关键。笔者观察预防性使用乌司他丁对行ERCP术患者的影响,报道如下。1临床资料1.1一般资料我院2010年1月—2012年6月行     

良性胆系疾病逆行胆胰管造影术后胰腺炎的危险因素分析

目的探讨良性胆系疾病逆行胆胰管造影(endoscopic retrograde cholangiopancreatography,ERCP)诊疗术后胰腺炎的危险因素。方法采用SPSS 11.0统计软件对169例良性胆系疾病ERCP诊疗患者从临床病理和技术操作分析ERCP术后胰腺炎(post-ERCP pancreatitis,PEP)的危险因素。结果169例患者出现11例PEP,发生率6.5%;43例诊断性ERCP中PEP 3例,发生率7.0%;126例治疗性ERCP中PEP 8例,发生率6.3%,两组PEP发生率比较无统计学差异(P>0.05)。单因素分析胆总管直径<10 mm、Oddis括约肌运动功能障碍(sphincter of Oddis dysfunction,SOD)、多次胰管插管差异有统计学意义(P<0.05);鼻胆管引流对PEP有预防作用(P<0.05)。Logistic回归分析提示SOD、多次胰管插管是PEP的危险因素(OR值分别为7.227、20.100);鼻胆管引流是PEP的保护因素(OR值为0.192)。结论SOD患者是PEP的危险人群,胆总管直径正常患者也应警惕,多次胰管插管是PEP...     

ERCP术后胰腺炎的药物预防

内镜逆行胆胰管造影术（ERCP）是当前诊断肝、胆、胰疾病的重要手段之一。开展近30年来，已广泛应用于临床。ERCP的术后并发症包括疼痛、出血、高淀粉酶血症和急性胰腺炎等。尤其是急性胰腺炎，为ERCP的严重并发症。如何经济、有效地预防ERCP术后的急性胰腺炎是重要的临床研究课题，近年来亦有大量各类药物预防的报道。本文将对ERCP术后胰腺炎（Post-ERCP Pancreatitis，PEP）的定义、发病机制、危险因素及药物预防作一综述。     

ERCP术后急性胰腺炎27例的防治体会

目的探讨ERCP术后急性胰腺炎(PEP)的预防及治疗方法.方法回顾性总结黄山市人民医院2006年1月至2012年12月380例ERCP术后引起急性胰腺炎27例的临床资料,分析临床诊疗经过及预后.结果380例ERCP病人中出现术后急性胰腺炎27例,其中22例为轻型急性胰腺炎,5例为重症急性胰腺炎.通过积极的诊断治疗,27例ERCP术后急性胰腺炎病人均经保守治疗成功.结论严格掌握ERCP适应证、术前充分评估病人危险因素、术后早期诊断,是预防及治疗PEP的关键.     

经内镜逆行胰胆管造影术后急性胰腺炎的危险因素分析

目的探讨经内镜逆行胰胆管造影（ERCP）术后急性胰腺炎（PEP）的危险因素。方法分析360例诊断性和治疗性ERCP患者的临床资料,对比分析术后PEP发生的危险因素。结果急性胰腺炎病史、括约肌功能障碍（SOD）患者为PEP高危人群,操作中胰管多次显影、乳头多次插管和预切开是PEP的高危因素（均P〈0.05）,而十二指肠憩室、操作过程中乳头括约肌切开、导丝辅助插管等与PEP无关（均P〉0.05）。结论相关危险因素中,患者本身的高危因素和操作技术同样重要,有效预防与规范操作可有效降低术后PEP发生率。     

国内胰管支架置入预防内镜逆行胰胆管造影术后胰腺炎的Meta分析

目的系统评价国内胰管支架置入术对内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)的预防效果及安全性。方法计算机检索从建库至2015年5月中国知网、万方数据库、中国学术期刊全文数据库、中国生物医学文献数据库、维普(VIP)、PubMed、Medline数据库等,收集国内胰管支架置入预防PEP的临床随机对照试验。由2名研究者按纳入、排除标准独立选择,提取资料,并对纳入文献进行质量方法学评估,使用RevMan5.2软件进行Meta分析。结果共纳入9项研究1 025例患者。Meta分析结果显示,试验组可降低PEP的发生率(OR=0.20,95%CI0.13~0.32,P<0.01;NNT=6)及重度PEP的发生率(OR=0.16,95%CI 0.05~0.53,P=0.003;NNT=25),高淀粉酶血症发生率的判定共纳入2项研究,包括试验组86例和对照组79例,试验组术后高淀粉酶血症发生率明显低于对照组(OR=0.33,95%CI 0.16~0.70,P=0.004,NNT=5)。结论国内胰管支架置入术可降低PEP和重度。PEP的发生率,可能是预防PEP的有效方法。     

内镜逆行胰胆管造影术后胰腺炎的防治进展

经内镜逆行胰胆管造影术(ERCP)是肝胆胰疾病重要的诊治手段,尤其是治疗性ERCP在肝胆胰疾病的微创治疗中占有越来越重要的地位,已越来越多地应用于临床。因ERCP是有创技术,难免出现一些并发症,ERCP术后胰腺炎是常见的并发症,发生率较高,其发生主要与胰管显影、插管困难等诸多因素有关。虽然ERCP术后胰腺炎的防治方法很多,如术前预防用药、术中放置胰管支架、鼻胆管引流等,但ERCP术后胰腺炎的发生仍是困扰临床医师的一大难题,随着ERCP诊治技术的广泛开展,其防治已成为热点,近年取得了一定的进展。     

Is prophylactic somatostatin effective to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis or hyperamylasemia? A randomized, placebo-controlled pilot trial

Background Effects of prophylactic somatostatin on post-endoscopic retrograde cholangiopancreatography (ERCP)pancreatitis (PEP) and hyperamylasemia remain inconclusive.This study aimed to examine whether high-dose,long-term continuous infusion of somatostatin can reduce the incidence of PEP and post-ERCP hyperamylasemia.Methods This was a randomized,placebo-controlled pilot trial.One hundred and twenty-four patients scheduled for ERCP from December 2008 to May 2010 randomly received one of the following three interventions:pre-ERCP somatostatin (0.5 mg/h for 24 hours,starting 1 hour prior to ERCP; n=36),post-ERCP somatostatin (0.5 mg/h for 24 hours,starting 1 hour after ERCP; n=47),or placebo (saline for 24 hours,starting 1 hour prior to ERCP; n=41).Serum amylase and lipase concentrations were measured 1 to 3 hours prior to ERCP and 6,24,and 48 hours after ERCP.Results The three groups did not differ in age,gender,medical history,or ERCP procedure (catheterization using contrast or guidewire,pancreatic duct visualization,procedure time,or procedure type).The rate of PEP was 13.7％ (17/124)in the overall study sample and 16.7％ (6/36),10.6％ (5/47),and 14.6％ (6/41) in the pre-ERCP somatostatin,postERCP somatostatin,and placebo groups,respectively (P=0.715).The rate of post-ERCP hyperamylasemia was 19.4％ (7/36),21.3％ (10/47),and 46.3％ (19/41) in the pre-ERCP somatostatin,post-ERCP somatostatin,and placebo groups,respectively (P=0.011).Conclusions High-dose,long-term continuous infusion (0.5 mg/h for 24 hours) of somatostatin,performed as either a pre-or post-ERCP,can reduce the incidence of hyperamylasemia,but not PEP.     

非甾体类抗炎药直肠给药预防ERCP术后胰腺炎的系统评价

目的评价非甾体类抗炎药（NSAIDs）直肠给药预防ERCP术后胰腺炎的有效性和安全性。方法制定严格纳入和排除标准,计算机检索Coehrane图书馆临床对照试验、Medline、PubMed、Embase、OVID数据库、中国生物医学文献数据库（CBMDisc）、维普中文期刊数据库、中国期刊全文数据库、万方学位论文数据库）。并手工检索相关会议论文集及查阅检索到的所有参考文献,全面收集国内外关于非甾体类抗炎药直肠给药预防ERCP术后胰腺炎的随机对照试验。按照国际Cochrane协作网推荐的方法进行系统评价。结果共纳入10个试验2802例患者,Meta分析显示：①PEP发生率、轻症PEP发生率及中一重症PEP发生率：NSAIDs治疗组优于安慰剂组（均P〈0．001）。②术后高胰淀粉酶血症发生率及术后血胰淀粉酶水平：NSAIDs治疗组优于安慰剂组（均Pd0．001）。③PEP病死率及不良反应发生率：无病死率及NSAIDs治疗相关不良反应的报道。结论NSAIDs直肠给药可以预防ERCP术后胰腺炎的发生,且安全性好。     

ERCP 联合EST治疗与患者术后发生急性胰腺炎关系的Meta分析

目的探讨实施内镜逆行胰胆管造影术联合乳头括约肌切开术治疗与患者发生术后胰腺炎的关系。方法全面检索2013年7月以前公开发表的实施内镜逆行胰胆管造影术联合乳头括约肌切开术治疗与患者发生术后胰腺炎关系的文献,采用RevMan5．1．4版本软件对文献数据进行综合分析。结果检索并纳入关于实施内镜逆行胰胆管造影术联合乳头括约肌切开术治疗与患者发生术后胰腺炎关系的文献共11篇,患者共3294例,其中单纯内镜逆行胰胆管造影术组患者2181例,内镜逆行胰胆管造影术联合乳头括约肌切开术组患者1113例。实施内镜逆行胰胆管造影术联合乳头括约肌切开术治疗与单纯实施内镜逆行胰胆管造影术检查患者术后胰腺炎发生率的合并优势比为2．27[95％可信区间（1．11,4．65）],P=0．03,差异有统计学意义。结论对患者实施内镜逆行胰胆管造影术联合乳头括约肌切开术治疗与单纯实施内镜逆行胰胆管造影术检查相比,前者术后发生术后胰腺炎的几率明显增大,应引起临床医师的重视。     

胰管支架预防胆总管结石ERCP术后并发症的临床研究

目的 探讨胰管塑料支架结合鼻胆管引流对复杂、难治性胆总管结石患者内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)及高淀粉酶血症的预防作用。 方法 选择2016年1月—2018年4月于淄博市中心医院消化内镜中心经ERCP治疗的113例复杂、难治性胆总管结石患者,采用随机数字表法随机分成2组,对照组(57例)仅在ERCP胆总管取石术后行鼻胆管引流,支架组(56例)行胰管插管留置导丝后常规胆管插管、胆管取石术后置入胰管支架、鼻胆引流管。比较2组患者在ERCP术后结石清除率、胰腺炎及严重程度、高淀粉酶血症发生率以及术后患者腹痛评分结果。 结果 对照组57例患者,结石完全清除47例(82.46%),PEP 10例(17.54%),重症PEP2例(3.51%),高淀粉酶血症15例(26.32%),术后患者腹痛评分(4.33±1.09)分;支架组56例患者,结石完全清除45例(80.36%),PEP 3例(5.36%),无重症PEP,高淀粉酶血症6例(10.71%),术后患者腹痛评分为(3.56±1.37)分。支架组ERCP术后PEP、高淀粉酶血症及术后腹痛评分明显少于对照组(均P＜0.05),结石完全清除率、重症PEP发生率差异无统计学意义(均P>0.05)。 结论 复杂、难治性胆总管结石患者ERCP治疗术后可通过放置胰管支架和鼻胆管引流减少术后PEP、高淀粉酶血症的发生,减轻患者腹痛程度,但对结石清除率、重症PEP发生率无明显影响。      

Preventive effect of ulinastatin and gabexate mesylate on post-endoscopic retrograde cholangiopancreatography pancreatitis

Background Post-endoscopic retrograde cholangiopancreatography pancreatitis （PEP） is regarded as one of the worrisome complications of endoscopic retrograde cholangiopancreatography （ERCP）. Results of randomized controlled trials evaluating the preventive effect of ulinastatin and gabexate mesylate （GM） on PEP are contradictory. The present study was designed to evaluate the prophylactic effect of ulinastatin and GM on PEP with meta-analyses of randomized controlled trials （RCTs）. Methods Five electronic databases were searched for RCTs evaluating the preventive effect of ulinastatin and GM on PEP. Summary effects were assessed with the methods recommended by the Cochrane Collaboration. Results Twelve studies involving 5105 participants were included in our meta-analyses. Administration of ulinastatin decreased the incidence of PEP only at sufficient doses （OR, 0.39; 95% C/, 0.19 to 0.81; P=0.01）. Number needed to treat （NNT） was 6. And administration of ulinastatin also reduced the incidence of post-ERCP hyperamylasemia （PEHA） （OR, 0.40; 95% C/, 0.28 to 0.58; P〈0.000 01）. Slow infusion of high-dose GM was effective for PEP prevention （OR, 0.44; 95% Cl, 0.25 to 0.79; P=0.006）, and rapid infusion of low-dose GM also showed efficacy for PEP prophylaxis （OR, 0.37; 95% C/, 0.20 to 0.69; P=0.002）. NNT was 7 and 6 respectively. However, administration of GM at low doses and by slow infusions was ineffective （OR, 0.99; 95% Cl, 0.64 to 1.55; P=0.98）. Administration of GM had the tendency to reduce PEHA rate, but not to a statistical significance （OR, 0.86; 95% CI, 0.73 to 1.01; P=0.06）. When low-quality studies were excluded, the meta-analysis with two high-quality studies indicated that ulinastatin did not reduce the rate of PEP （OR, 0.63; 95% Cl, 0.32 to 1.26; P=0.19） and PEHA incidence （OR, 0.80; 95% Cl, 0.31 to 2.07; P=0.64）. The meta-analysis with six high-quality studies showed that GM administration decreased PEP incidence （OR, 0.52; 95% CI, 0.29 to 0.91; P=-0,02）, while was not efficacious for PEHA prevention （OR, 0.88; 95% C/, 0.74 to 1.04; P=0.12）. Conclusions Ulinastatin and GM may be of value for the prophylaxis of PEP. GM should be administered at high doses and by rapid infusions. And the doses of ulinastatin should be sufficient. However, the conclusions are not overwhelming. More large-sample size and high-quality RCTs are still needed to elucidate whether administrations of the two drugs really have prophylactic effect on PEP.     

生长抑素及胰管支架置入预防内镜逆行胰胆管造影术后胰腺炎的临床研究

目的：探讨预防性应用生长抑素及术后放置胰管支架对经内镜逆行胰胆管造影（ERCP）术后胰腺炎（PEP）及高淀粉酶血症的预防效果。方法将120例行ERCP诊治的高危患者随机分为3组,生长抑素组36例,胰管支架组48例,对照组36例。观察PEP、高淀粉酶血症的发生情况、病情恢复情况。结果3组患者中PEP总发生率为17.5%（21/120）,高淀粉酶血症为4.2%（5/120）。对照组PEP、高淀粉酶血症发生率（30.6%、8.3%）明显高于生长抑素组（16.7%、2.8%）和胰管支架组（8.3%、2.1%）,差异有统计学意义（P 〈0.05）。胰管支架组两者的发生率低于生长抑素组（P 〈0.05）。术后6 h 生长抑素组血清淀粉酶（467±631）U/L、胰管支架组为（501±405）U/L,明显低于对照组[（1323±461）U/L],差异有统计学意义（P 〈0.05）;但3组术后24 h血清淀粉酶水平无明显差异（P 〉0.05）。生长抑素组及胰管支架组胰腺炎患者腹部症状体征消失时间、白细胞计数降至正常时间、平均住院日均较对照组明显缩短,差异有统计学意义（P 〈0.05）。结论生长抑素、胰管支架置入均可有效预防PEP及高淀粉酶血症的发生。     

Evaluation of the metabolism of PEP06, an endostatin-RGDRGD 30-amino-acid polypeptide and a promising novel drug for targeting tumor cells

PEP06 is a novel endostatin-Arg-Gly-Asp-Arg-Gly-Asp (RGDRGD) 30-amino-acid polypeptide featuring a terminally fused RGDRGD hexapeptide at the N terminus. The active endostatin fragment of PEP06 directly targets tumor cells and exerts an antitumoral effect. However, little is known about the kinetics and degradation products of PEP06 in vitro or in vivo. In this study, we investigated the in vitro metabolic stability of PEP06 after it was incubated with living cells obtained from animals of different species; we further identified the degradation characteristics of its cleavage products. PEP06 underwent rapid enzymatic degradation in multiple types of living cells, and the liver, kidney, and blood play important roles in the metabolism and clearance of the peptides resulting from the molecular degradation of PEP06. We identified metabolites of PEP06 using full-scan mass spectrometry (MS) and tandem MS (MS²), wherein 43 metabolites were characterized and identified as the degradation metabolites from the parent peptide, formed by successive losses of amino acids. The metabolites were C and N terminal truncated products of PEP06. The structures of 11 metabolites (M6, M7, M16, M17, M21, M25, M33, M34, M39, M40, and M42) were further confirmed by comparing the retention times of similar full MS spectrum and MS² spectrum information with reference standards for the synthesized metabolites. We have demonstrated the metabolic stability of PEP06 in vitro and identified a series of potentially bioactive downstream metabolites of PEP06, which can support further drug research.     

原发性癫痫患者血清可溶性白细胞介素2受体水平的观察

采用双本夹心ＥＬＩＳＡ法对４３例原发性癫痫患者和５６例正常对照血清可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平进行检测。结果显示癫痫组血清ｓＩＬ－２Ｒ水平显著高于下沉对照组，血清ｓＩＬ－２Ｒ民癫痫患者的年龄，性别、病程无关，抗癫痫药物对癫痫患者血清ｓＩＬ－２Ｒ水平无明显影响。结果提示癫痫患者存在细胞免疫功能异常，Ｔ淋巴细胞处于活化状态。