预防ERCP术后胰腺炎的临床研究

目的探讨内镜逆行胰胆管造影(ERCP)术后胰腺炎的预防措施。方法行ERCP患者164例,随机分为2组预防组82例,分别于术前3 0min皮下注射善宁0 1mg ,术后2 4h连续静脉滴注善宁针0 4mg ;对照组82例,ERCP术前术后不用善宁。2组患者术前、术后均不用其他任何抑制胰腺分泌及预防胰腺炎药物,并分别于术前、术后3、2 4h作血清淀粉酶测定,术前、术后2 4h作血清C反应蛋白(CRP)测定,同时观察胰腺炎的发生情况。结果预防组ERCP术后3、2 4h血淀粉酶分别为( 164±12 5 )U/L和( 2 0 4±195 )U/L ,明显低于对照组的( 2 79±2 0 1)U/L和( 4 98±3 82 )U/L(P <0 0 5 ) ;预防组血CRP明显低于对照组,预防组胰腺炎发生5例( 6 1% )明显低于对照组11例( 13 4% ) (P <0 0 5 )。结论ERCP术前及术后2 4h持续应用善宁有助于预防ERCP术后胰腺炎、减少组织损伤。

CLINICAL STUDY ON PERVENTION OF POST ERCP

Objective To study the preventive effect of sandostadin on the hyperamylasemia and pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP). Methods 164 ERCP patients received either sandostadin (0.1 mg, subcutaneous injection before ERCP and 0.4 mg, successive 24 h vein injection post ERCP) or no injection as placebo. The cases were equally divided into two groups. The mean concentrations of serum amylase at 3 h and 24 h after ERCP and C-response protein were measured in all patients, and the abdominal pain and pancreatitis after ERCP were also observed in all patients. Results The mean concentrations of serum amylase (U/L) at 3 h and 24 h post were 164±125 and 204±195 in the preventive group, and 279±201 and 498±382 (P<0.05) in the control group. Eleven cases(13.4%) occurred acute pancreatitis in the control group but only five cases (6.1%) in preventive group after ERCP (P<0.05). The mean concentration of serum amylase and the number of pancreatitis after ERCP was significantly lower in the preventive group than that in the control group(P<0.05). CRP of serum after ERCP was also significantly lower in the preventive group than that in the control group. Conclusions Sandostadin used in pre-ERCP and successive 24 h post-ERCP can prevent effectively hyperamylasemia and acute pancreatitis after ERCP. Meanwhile, it could reduce tissue damage.