ENBD预防胆管多发结石ERCP术后急性胰腺炎及高淀粉酶血症65例

目的:探讨内镜鼻胆管引流术(ENBD)预防胆总管多发结石患者内镜逆行胰胆管造影(ERCP)术后急性胰腺炎及高淀粉酶血症的价值.方法:收集我院胆总管多发结石患者141例(ENBD组65例,常规治疗组77例),比较两组并发症的发生和治疗的情况.结果:ENBD组和常规治疗组相比,术后2h及术后24 h的血淀粉酶、术后高淀粉酶血症发生率及ERCP术后急性胰腺炎的发生率均有显著性差异(67.3 U/L±9.1U/L vs 98.3 U/L±11.2 U/L.89.5 U/L±13.0 U/L vs 126.2 U/L±14.2 U/L,圴P＜0.01).结论:ENBD可以有效预防胆总管多发结石患者ERCP术后急性胰腺炎及高淀粉酶血症.     

超声内镜引导不同型号细针穿刺胰腺占位病灶的前瞻随机对照研究

目的 通过分析EUS-FNA获得的细胞量及细胞学诊断结果,比较3种不同型号穿刺针在胰腺实性占位诊断中的差异.方法 纳入2010年12月至2011年5月期间两家医院胰腺实质性占位病灶长轴直径大于2 cm并进行EUS-FNA的病例.根据穿刺途径将患者分为经胃壁穿刺组(19 G或22 G或25 G)和经十二指肠壁穿刺组(22 G或25 G),分别按事先设置的随机表随机选择穿刺针型号进行EUS-FNA.穿刺过程中,固定穿刺次数、吸引负压、穿刺针在病灶内移动次数和移动距离,穿刺内容物送液基细胞学检查,由同一位细胞学医生制片及诊断对EUS-FNA获得的细胞量及细胞学诊断结果进行比较.结果 研究共纳入病例52例,经胃壁穿刺组42例,经十二指肠壁穿刺组10例.所有病例均成功完成穿刺操作并未出现与EUS-FNA操作相关的并发症.两个穿刺组中不同型号穿刺针所获得的细胞总量、细胞学诊断之间的差异均无统计学意义(P＞0.05).但在两组中25 G穿刺针的诊断敏感度、特异度、阳性预测值、阴性预测值和准确率均稍高.结论 EUS-FNA在胰腺实质性占位中具有较高的诊断价值,尽管25 G穿刺针对胰腺病灶的诊断略显优势,但3种不同型号的穿刺针获得的细胞量及细胞学诊断并无显著差异.     

ENBD预防胆总管结石ERCP术后急性胰腺炎及高淀粉酶血症的临床价值

目的观察内镜鼻胆管引流术(ENBD)预防内镜逆行胰胆管造影术(ERCP)术后急性胰腺炎及高淀粉酶血症的效果。方法收集我院胆总管结石行ERCP取石术的患者367例,其中ENBD组309例,对照组58例,比较两组术后2 h及24 h血清淀粉酶值、高淀粉酶血症及急性胰腺炎的发生率。结果 ENBD组术后2 h、24 h的血清淀粉酶值分别为(396.6±240.3)U/L和(620.8±345.5)U/L,明显低于对照组的(593.9±470.5)U/L和(1 074.0±609.1)U/L(P<0.05);ENBD组有42例发生高淀粉酶血症(13.6%)、15例发生急性胰腺炎(4.9%),对照组则分别为13例(22.4%)和8例(13.8%),两组比较差异均有统计学意义(P<0.05)。结论 ENBD能有效预防胆总管结石患者ERCP术后急性胰腺炎及高淀粉酶血症的发生。     

儿童胰腺炎ERCP术后并发症研究

目的分析儿童胰腺炎患者经内镜逆行胰胆管造影(endoscopic retrograde cholangiop-ancreatography, ERCP)术后高淀粉酶血症、胰腺炎及出血等并发症的发生率,探讨其安全性.方法回顾分析1997年2月～2002年2月间入住我科确诊为儿童胰腺炎并行ERCP术的27例患者的临床资料,其中急性胰腺炎(acute pancreatitis,AP)14例,慢性胰腺炎(chronic pancreatitis,CP)13例;诊断性ERCP 9例,治疗性ERCP18例.结果 27例患者ERCP术后总体并发症发生率为51.85%(14/27),其中,高淀粉酶血症发生率22.22%(6/27),术后4、24 h血清淀粉酶水平分别为(410.75±230.31) U/L、(367.25±233.90) U/L,48～72h后均恢复正常;胰腺炎发生率22.22%(6/27),均为轻型胰腺炎;乳头切开处出血、黑便发生率7.41%(2/27),均发生于胆总管结石行十二指肠乳头括约肌切开(endoscopic sphincterotomy,EST)+取石术后;诊断性ERCP组并发症的发生率低于治疗性ERCP组,但无统计学意义.结论儿童胰腺炎患者ERCP术后具有较高的并发症发生率,内镜医师于ERCP术中应高度重视,采取必要的预防措施以减少并发症的发生.     

胰管支架预防高危ERCP术后胰腺炎的临床分析

目的 观察胰管支架置人预防高危患者内镜逆行胰胆管造影（ERCP）术后胰腺炎及高淀粉酶血症的效果.方法 将确定有ERCP指征并符合纳入标准的72例高危患者按照随机数字表法分为胰管支架组和对照组,每组36例.比较两组术后3h、24 h血清淀粉酶水平及高淀粉酶血症、急性胰腺炎、重症胰腺炎的发生率.结果 胰管支架组术后3h和术后24 h血淀粉酶值分别为（128.68±173.35） U/L和（92.41±88.44） U/L,均低于对照组（432.37 ±515.20） U/L和（465.89±736.54） U/L,差异有统计学意义（P＜0.05）;胰管支架组术后高淀粉酶血症、急性胰腺炎、重症胰腺炎的发生率分别为5.6％、2.8％、0,对照组为22.2％、16.7％、11.1％,两组比较差异有统计学意义（P＜0.05）.结论 胰管支架置入能明显降低高危患者ERCP术后高淀粉酶血症、急性胰腺炎及重症胰腺炎的发生率.     

内镜超声引导下细针穿刺活检术对腹腔占位病灶的诊断价值

目的探讨内镜超声引导下细针穿刺活检术(EUS-FNA)对腹腔占位病灶的诊断价值和安全性。方法收集2009-05～2011-06因腹腔占位行EUS-FNA的患者19例,回顾性分析EUS-FNS病理的阳性率及EUS-FNA与手术后病理的符合率。结果 19例患者穿刺病理结果,腺癌11例,假性乳头状瘤1例,胰腺导管内乳头状黏液瘤(IPMT)1例,炎性改变6例,穿刺检查阳性率为68.4%。其中7例行手术治疗,术后病理与穿刺标本病理或细胞学结果符合6例,符合率为86.0%。本组19例患者EUS-FNA术后无出血、穿孔、感染及急性胰腺炎等并发症。结论 EUS-FNA是一项准确而安全有效的技术,对腹腔占位病灶尤其是胰腺肿瘤的定性诊断及进一步治疗方案的确定具有重要的临床价值。     

儿童胰腺炎ERCP术后并发症研究

目的 分析儿童胰腺炎患者经内镜逆行胰胆管造影(endoscopic retrograde cholangiop-ancreatography,ERCP)术后高淀粉酶血症、胰腺炎及出血等并发症的发生率,探讨其安全性。方法 回顾分析1997年2月～2002年2月间入住我科确诊为儿童胰腺炎并行ERCP术的27例患者的临床资料,其中急性胰腺炎(acute pancreatitis,AP)14例,慢性胰腺炎(chronic pancreatitis,CP)13例;诊断性ERCP 9例,治疗性ERCP18例。结果 27例患者ERCP术后总体并发症发生率为51.85％(l4/27),其中,高淀粉酶血症发生率22.22％(6/27),术后4、24h血清淀粉酶水平分别为(410.75±230.31)U/L、(367.25±233.90)U/L,48～72h后均恢复正常;胰腺炎发生率22.22％(6/27),均为轻型胰腺炎;乳头切开处出血、黑便发生率7.41％(2/27),均发生于胆总管结石行十二指肠乳头括约肌切开(endoscopicsphincterotomy,EST)+取石术后;诊断性ERCP组并发症的发生率低于治疗性ERCP组,但无统计学意义。结论 儿童胰腺炎患者ERCP术后具有较高的并发症发生率,内镜医师于ERCP术中应高度重视,采取必要的预防措施以减少并发症的发生。     

ERBD预防ERCP术后高淀粉酶血症及胰腺炎临床分析

目的探讨内镜鼻胆管引流术（ENBD）预防内镜逆行胰胆管造影（ERCP）术后高淀粉酶血症及胰腺炎的临床疗效。方法胆石症行ERCP术患者160例,随机分为观察组85例和对照组65例,观察组术后置鼻胆管引流,对照组术后静脉滴注5％GS500ml＋法莫替丁20mg／d。分别于术前、术后3h、24h抽血,检测血淀粉酶（AMY）水平。结果两组术后3、24h血AMY明显高于术前;观察组术后3、24h血AMY明显低于对照组（P均〈0．05）;观察组发生高淀粉酶血症（AMY〉420U／L）2例,无胰腺炎发生,对照组发生高淀粉酶血症9例,急性胰腺炎5例。结论ERBD对ERCP术后预防高淀粉酶及胰腺炎有一定的临床价值。     

腹腔镜联合胆道镜在重症急性胰腺炎继发胰腺脓肿中的应用

目的:探讨腹腔镜、胆道镜联合应用在重症急性胰腺炎继发胰腺脓肿中的临床应用价值.方法:回顾性分析我院2000-06/2011-06随机使用腹腔镜、胆道镜联合及开腹手术治疗重症急性胰腺炎继发胰腺脓肿的38例患者,包括一般资料、手术时间、术中出血量、术后肠道功能恢复时间、术后白细胞、肝功能变化、术后并发症、死亡率、住院时间、住院费用等.结果:腹腔镜、胆道镜联合治疗组和开腹组在患者组成、手术时间、住院时间、死亡率等方面无统计学差异,治疗组在术中失血量(108.2 mL±18.1 mLvs 137.4 mL±25.2 mL)、术后肠道恢复时间(26.8 h±9.7 h vs 31 h±10.1 h)、术后肝功能变化(碱性磷酸酶:76.7U/L±12.6 U/L vs 83.2 U/L±13.6 U/L;谷氨酰转肽酶计数:60.3 U/L±14.1 U/L vs 67.1 U/L±13.8 U/L)、术后并发症(19.0%vs 41.2%)、住院费用(49.3千元±0.9千元vs 43.2千元±0.6千元)上与对照组差异显著(P<0.05).结论:腹腔镜、胆道镜联合治疗重症急性胰腺炎继发胰腺脓肿安全可靠、更加合理,有一定临床意义,但其费用较高,手术时间及住院时间稍长,需加以改进.     

急性胰腺炎患者血淀粉酶变化和CT诊断的比较

目的探讨血淀粉酶的变化规律及其机制。方法本研究对确诊的172例急性胰腺炎(AP)患者随机分为3组,分别在发病≤12 h、12～24 h、48～72 h行CT和血淀粉酶检查。分析不同时间段CT和血淀粉酶检出率。结果 87.5%患者血淀粉酶在6～12 h升高;100%患者血淀粉酶在12 h以上升高。91.3%的患者在12～24 h之间CT检查发现胰腺炎症变化,但与发病大于48 h相比,无显著差异。12 h之内,血淀粉酶升高的阳性率高于CT诊断的阳性率(χ2=22.04,P<0.01)。48～72 h D级、E级检出率明显高于12 h之内和12～24 h之间的检出率。血淀粉酶随着轻症急性胰腺炎分级水平有上升趋势;随着重症急性胰腺炎分级水平有下降趋势。结论血淀粉酶升高的水平与胰腺炎的病情程度无明显相关性,推测其机制可能与胰腺微循环受损程度有关。     

经皮胆道支架植入术后高淀粉酶血症和胰腺炎的发生率及危险因素分析

目的分析经皮肝穿刺胆道支架植入(PTBS)术后高淀粉酶血症和急性胰腺炎的临床特征,探讨其相关危险因素。方法回顾性收集2016年3月—2020年2月于南京医科大学第一附属医院介入放射科收治且接受PTBS治疗的249例恶性胆道梗阻患者的临床资料。根据术后患者有无高淀粉酶血症或急性胰腺炎,将所有患者分为高淀粉酶血症和胰腺炎组(n=55)、无高淀粉酶血症和胰腺炎组(n=194),并分析其发生率、严重程度及相关危险因素。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ²检验。将上述单因素分析中P<0.1的因素纳入多因素logistic回归分析,探究PTBS术后高淀粉酶血症和急性胰腺炎的独立危险因素。结果PTBS术后,共55例(22.1%)发生血清淀粉酶异常升高,其中26例(10.4%)诊断为高淀粉酶血症,29例(11.7%)诊断为急性胰腺炎。所有胰腺炎均表现为轻度。多因素logistic回归分析发现,年龄(≤60岁)(OR=2.2,95%CI:1.07~4.52,P=0.033)、碘-125粒子条植入(OR=2.8,95%CI:1.21~6.45,P=0.016)、胆道支架跨乳头释放(OR=6.3,95%CI:2.85~14.05,P<0.001)及术中胰管显影(OR=13.9,95%CI:5.64~34.03,P<0.001)是PTBS术后高淀粉酶血症和急性胰腺炎的危险因素。结论高淀粉酶血症和急性胰腺炎是PTBS术后相对常见的并发症。年龄≤60岁、同期碘粒子条植入、胆道支架跨乳头释放及术中胰管显影是PTBS术后发生高淀粉酶血症和胰腺炎的独立风险因素。     

直肠非甾体类抗炎药对ERCP术后胰腺炎的预防作用

目的观察直肠非甾体类抗炎药（NSAIDs）对ERCP术后高淀粉酶血症及胰腺炎的预防及治疗作用。方法将符合标准的患者随机分为2组，每组30例。预防组在ERCP术前30min肌注地西泮及山莨菪碱各10mg，同时给予引哚美辛栓100mg塞肛；对照组在ERCP术前30min肌注地西泮及山莨菪碱各10mg。ERCP术前及术后6h、24h测定血清淀粉酶水平。结果比较预防组和对照组ERCP术后6h、24h血清淀粉酶的活性，发现ERCP术后6h两组间血清淀粉酶分别为（367．5±268．7）U／L、（1034．2±713．5）U／L，术后24h两组间血清淀粉酶分别为（324．9±142．3）U／L、（826．8±395．7）U／L，两组问差异均有统计学意义（P〈0．05）。结论直肠NSAIDs具有预防ERCP术后高淀粉酶血症及胰腺炎的作用。     

非甾体类抗炎药对内镜下逆行性胰胆管造影术后急性胰腺炎的预防作用

[目的]观察非甾体类抗炎药(NSAIDs)对逆行性胰胆管造影术(ERCP)后高淀粉酶血症及胰腺炎的预防作用。[方法]将符合标准的患者随机分为2组,消炎痛组48例,安慰剂组42例。2组在ERCP前30min均肌内注射地西泮及654-2各10mg,消炎痛组于取石术后立即使用消炎痛栓0.1g纳肛,安慰剂组在ERCP术后立即使用安慰剂纳肛。分别测定ERCP术前及术后6、24h血清淀粉酶水平。[结果]2组患者术前血清淀粉酶水平比较差异无统计学意义,ERCP术后6h消炎痛组和安慰剂组血清淀粉酶分别为(384.9±256.8)U/L和(1 042.7±725.4)U/L,术后24h2组间血清淀粉酶分别为(301.3±104.2)U/L和(789.5±298.7)U/L,2组间比较差异均有统计学意义(P<0.05)。[结论]NSAIDs具有预防ERCP术后高淀粉酶血症及胰腺炎的作用。     

Predictive factors for acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation

BACKGROUND: Although endoscopic papillary balloon dilation may result in acute pancreatitis or hyperamylasemia, the risk factors for these complications have not been well documented. Risk factors predictive of acute pancreatitis and hyperamylasemia after endoscopic papillary balloon dilation were retrospectively analyzed. METHODS: In 118 patients who underwent endoscopic papillary balloon dilation for choledocholithiasis, postendoscopic papillary balloon dilation acute pancreatitis and hyperamylasemia (at least 3-fold elevation) were investigated. A multivariate analysis was conducted for 20 potential risk factors related to clinical and procedure characteristics. RESULTS: Bile duct clearance was achieved in 113 patients. Early complications in the form of mild pancreatitis occurred in 7 patients (6%). Multivariate analysis identified history of acute pancreatitis as the only risk factor for postendoscopic papillary balloon dilation pancreatitis. Postendoscopic papillary balloon dilation hyperamylasemia occurred in 30 patients (25%). Multivariate analysis identified 4 independent risk factors for hyperamylasemia: an age of 60 years or less, previous pancreatitis, bile duct diameter 9 mm or less, and difficult bile duct cannulation. CONCLUSIONS: Endoscopic papillary balloon dilation is associated with a relatively low occurrence (6%) of pancreatitis but a high frequency (25%) of hyperamylasemia. The latter may represent pancreatic irritation or latent pancreatic injury. Particular care is necessary when endoscopic papillary balloon dilation is performed in younger patients, those with a history of pancreatitis, patients with a nondilated bile duct, and when cannulation is difficult.     

Hyperamylasaemia and acute pancreatitis following endoscopic retrograde cholangiopancreatography

Hyperamylasaemia and acute pancreatitis are the more common complications of endoscopic retrograde cholangiopancreatography (ERCP). Ninety patients who underwent ERCP +/- endoscopic papillotomy were monitored for rises in the serum amylase and the development of acute pancreatitis. The incidence of hyperamylasaemia (greater than 300 IU/L) was significantly greater (p = 0.01) when the pancreatic duct was imaged (75%) than with bile duct imaging alone (33%). The incidence of acute pancreatitis following imaging of the pancreatic duct +/- bile duct was 11.3% and was found to be significantly increased in those patients (n = 9) who also underwent endoscopic papillotomy. Imaging of the biliary tree only +/- endoscopic papillotomy carried no significant risk of acute pancreatitis. In those patients who developed pancreatitis, the rise in serum amylase occurred early and was significantly higher at 2 h following ERCP. These findings may help to identify patients who are at risk of developing this complication.     

Elevated Serum Amylase Activity in the Absence of Clinical Pancreatic or Salivary Gland Disease

Elevated serum amylase activity, in the absence of clinically apparent pancreatic or salivary gland disease, has been observed in many seemingly unrelated conditions. In a search for common etiological factors to account for hyperamylasemia in these conditions, a retrospective analysis was performed. Eighty-four episodes of hyperamylasemia (> 300 I.U./l. Phadebas method) occurring in 75 patients over a one-year period ending in June, 1975 were assigned to one of two groups. Group 1 consisted of 56 (67%) episodes of hyperamylasemia with clinical pancreatitis. Group 2 consisted of 28 (33%) episodes of hyperamylasemia in the absence of clinical pancreatitis. Hypoxemia (pO₂ < 75 mm. Hg.) was found in 9/15 patients in Group 2 who had arterial blood gases measured. To assess the possible relationship between acute hypoxemia and amylase activity, a prospective study was initiated. Patients with known causes of pancreatitis or renal failure were eliminated. Hyperamylasemia was found in 3/8 hypoxemic patients. This raises the possibility that acute hypoxemia alone or in combination with other factors may raise serum amylase activity, possibly through ischemic injury to the pancreas or salivary glands or other amylase containing tissues.     

联合应用奥美拉唑和奥曲肽对ERCP术后胰腺炎的预防作用

目的 探讨质子泵抑制剂(奥美拉唑)预防诊疗性ERCP术后急性胰腺炎(AP)及高淀粉酶血症的临床效果.方法 250例ERCP操作成功的病例按数字表法随机分成对照组(126例)和治疗组(124例).在ERCP术后立即给予奥曲肽的基础上,治疗组给予静脉注射40 mg奥美拉唑注射液,12 h重复注射一次,对照组给予同等体积生理盐水.检测两组术后4、24 h血清淀粉酶及TNF-α的含量,观察术后胰腺炎的发生率.结果 两组患者在年龄、性别、ERCP操作时间和治疗性操作比例上均无显著统计学差异.治疗组术后4、24 h血清淀粉酶及TNF-α含量分别为(221±31)U/L、(181±39)U/L、(0.264±0.052)ng/ml和(0.257±0.071)ng/ml,显著低于对照组的(272±32)U/L、(227±30)U/L、(0.372±0.047)ng/ml和(0.422±0.026)ng/ml(P<0.05).治疗组胰腺炎发病率为1.6%,显著低于对照组的6.5%(P=0.04).结论 联合应用奥美拉唑和奥曲肽可以更有效地预防ERCP术后高淀粉酶血症和AP的发生.     

Pancreatic Hyperamylasemia and Hyperlipasemia in Association with Cytomegalovirus Infection Following Unrelated Cord Blood Transplantation for Acute Myelogenous Leukemia

Cytomegalovirus (CMV)-associated pancreatitis is rare after allogeneic hematopoietic stem cell transplantation (SCT). We describe a patient who developed pancreatic hyperamylasemia and hyperlipasemia in association with CMV infection after cord blood transplantation (CBT). A 31-year-old man with acute myelogenous leukemia underwent CBT. A neutrophil count consistently greater than 500/microL was achieved on day +21. Positive results for CMV antigenemia on days +35 and +67 prompted 2 courses of preemptive therapy with ganciclovir or foscarnet. The CMV antigenemia value again became positive on day +134. On day +141, serum amylase and lipase activities markedly increased to 1221 IU/L and 894 IU/L, respectively. The patient had no abdominal symptoms. Ultrasonography and computed tomography results showed no abnormalities of the pancreas. A diagnosis of possible pancreatitis was made. After the initiation of foscarnet therapy, the CMV antigenemia results soon became negative, and serum amylase and lipase activities returned to normal. Therefore, CMV infection was considered to play a major role in the development of pancreatic hyperamylasemia and hyperlipasemia in our patient. The present report indicates that CMV infection should be included in the differential diagnosis for patients with pancreatic hyperamylasemia after SCT.