间苯三酚预防胆总管结石ERCP术后胰腺炎的效果

目的：研究在胆总管结石患者接受经内镜逆行胆胰管造影(ERCP)术前，应用间苯三酚对预防术后胰腺炎的价值。方法选取2010年6月至2014年6月于我院肝胆外科接受ERCP治疗的胆总管结石患者38例，以随机数表法随机分为观察组和对照组各19例。对照组接受常规手术方案，术前应用地西泮、哌替啶、山莨菪碱；观察组在对照组基础上术前应用间苯三酚。比较两组患者术中不良反应、胃蠕动次数、手术时间，术前、术后6h、术后24 h的血清淀粉酶水平，术后高淀粉酶血症及急性胰腺炎发生率。结果观察组患者术中恶心呕吐1例、高血压2例，术中胃蠕动次数(1.6±0.5)次，分别低于对照组的6例、9例及(4.2±0.6)次，差异均有统计学意义(P<0.05)；观察组患者的手术时间为(34.7±6.7) min，明显短于对照组的(48.2±12.1) min，差异有统计学意义(P<0.05)；观察组患者术前、术后6 h，术后24 h的血清淀粉酶分别为(55.8±12.5) c·μ-1·L-1、(82.5±24.7) c·μ-1·L-1、(72.1±29.5) c·μ-1·L-1，对照组分别为(56.3±13.7) c·μ-1·L-1、(122.4±44.6) c·μ-1·L-1、(114.3±58.4) c·μ-1·L-1,两组患者术前接近，术后6 h、术后24 h均明显低于术前水平，差异均有统计学意义(P<0.05)，且术后各时点观察组血清淀粉酶低于对照组，差异均有统计学意义(P<0.05)；观察组患者术后高淀粉酶血症及急性胰腺炎总发生率为10.5%(2/19)，低于对照组的42.1%(8/19)，差异有统计学意义(P<0.05)。结论在常规ERCP方案的基础上，术前应用间苯三酚有助于预防胆总管结石患者术后急性胰腺炎。

Effect of phloroglucinol on the prevention of postoperative pancreatitis in patients with common bile duct stones after ERCP surgery

Objective To study the value of preoperative application of phloroglucinol in the prevention of postoperative pancreatitis in patients with common bile duct stones undergoing endoscopic retrograde cholangiopancrea-tography (ERCP). Methods Thirty-eight patients with common bile duct stones received ERCP treatment in Depart-ment of Hepatobiliary Surgery in our hospital from June 2014 to June 2015 were selected and randomly divided into the observation group (n=19) and the control group (n=19). The control group received conventional surgery scheme, with diazepam, pethidine and anisodamine applied preoperatively. The observation group additionally applied phloroglucinol preoperatively on the basis of the control group. The adverse reactions, gastric peristalsis times, operation time, the pre-operative, postoperative 6 h, 24 h serum amylase level, as well as the incidence of postoperative hyperamylasemia and acute pancreatitis were compared between the two groups. Results The nausea and vomiting, hypertension and intraopera-tive gastric motility times in observation group were significantly lower than those in the control group [1 case vs 6 cases, 2 cases vs 9 cases, (1.6 ± 0.5) times vs (4.2 ± 0.6) times, P<0.05]. The operation time of observation group was significantly shorter than that in the control group [(34.7±6.7) min vs (48.2±12.1) min, P<0.05]. The serum amylase levels showed no sta-tistically significant difference between the two groups before operation [(55.8±12.5) c·μ-1·L-1 vs (56.3±13.7) c·μ -1·L-1]. The levels in the two groups at postoperative 6 h, 24 h were significantly lower than the preoperative level (P<0.05), and the levels at each postoperative time point of the observation group were significantly lower than those of the control group [(82.5±24.7) c·μ-1·L-1 vs (122.4±44.6) c·μ-1·L-1;(72.1±29.5) c·μ-1·L-1 vs (114.3±58.4) c·μ-1·L-1, P<0.05]. The to-tal incidence rates of postoperative hyperamylasemia and acute pancreatitis in the observation group were significantly lower than those in the control group [10.5%(2/19) vs 42.1%(8/19), P<0.05]. Conclusion On the basis of conventional ERCP, preoperative application of phloroglucinol can help prevent postoperative acute pancreatitis in patients with com-mon bile duct stones.