胰管支架置入联合吲哚美辛栓纳肛预防困难胆管插管患者逆行胰胆管造影术后胰腺炎的临床研究

目的 探讨胰管支架置入联合吲哚美辛栓纳肛对困难胆管插管患者内镜下逆行胰胆管造影术(endoscopic ret-rograde cholangio-pancreatography,ERCP)术后胰腺炎的预防作用.方法 选取2012年1月至2016年11月我院ERCP术中发生困难胆管插管的患者108例,按随机数字表法随机分成4组,A组:单纯行胰管支架置入,B组:单纯行吲哚美辛栓纳肛,C组:胰管支架置入联合吲哚美辛栓纳肛,D组:无预防ERCP术后胰腺炎(post-ERCP pancreatitis,PEP)措施.分别检测术前、术后4 h、术后24 h血清淀粉酶水平,采用视觉模拟评分法(visual analogue score,VAS)对腹痛程度进行评分.对比各组ERCP术后患者血清淀粉酶水平、PEP发生率及术后腹痛评分.结果 术后4 h血清淀粉酶水平B组和C组均明显低于D组(P<0.05),术后24 h血清淀粉酶水平A组、B组和C组均明显低于D组(P<0.05).术后24 h PEP发生率A组和C组均为0%,明显低于D组7.4%(P<0.05).术后4 h、24 h各组疼痛程度VAS评分均明显高于术前(P<0.05);B组和C组术后4 h、24 h均明显低于D组(P<0.05);B组术后4 h、24 h均明显低于A组(P<0.05);A组仅术后24 h明显低于D组(P<0.05).结论 胰管支架置入联合吲哚美辛栓格纳肛可减少ERCP术后高淀粉酶血症的发生,可减少PEP发生率,减轻ERCP术后患者的腹痛评分,可以有效预防PEP和高淀粉酶血症.

Clinical research on the prophylactic effects of pancreatic duct stenting combined with non-storied anti-inflammatory drug on post endoscopic retrograde cholangiopancreatography pancreatitis in difficult bile duct cannulation

Objective To investigate the prophylactic effects of pancreatic duct stenting (PDS) combined with non-storied anti-inflammatory drug (NSAID) on post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in difficult bile duct cannulation .Methods One hundred and eight patients who experienced difficult bile duct cannulation during hospitalization from January 2012 to November 2016 in the Department of Gastroenterology of the hospital were enrolled for the study .The patients were ran-domly divided into 4 groups:i.e.Group A that underwent simple PDS , Group B that received NSAID , Group C that were treated with PDS combined with NSAID and Group D that had routine ERCP without preventive measures for PEP .The levels of serum amylase be-fore surgery, 4 and 24 hours after ERCP were observed closely .The scores of abdominal pain were evaluated by VAS method , and the levels of serum amylase , the rate of post ERCP and scores of abdominal pain after ERCP were compared between the 4 groups.Results Four hours after ERCP, serum amylase levels of group B and group C were all significantly lower that those of group D (P<0.05). Serum amylase levels of group A, B and C 24 hours after ERCP were all significantly lower that those of group D (P<0.05).The rate of PEP 24 hours after ERCP for group A and C was 0%, which was obviously lower than that of group D (7.4%)(P<0.05).The VAS scores of various groups 4 and 24 hours after ERCP were significantly higher than that before ERCP (P<0.05).The VAS scores of groups B and C 4 and 24 hours after ERCP were all significantly higher than that of group D (P<0.05), and the VAS scores of group B 4 and 24 hours after ERCP was obviously lower than that of group A (P<0.05).Only at hour 24 after ERCP, the VAS pain scores of group A were higher than that of group D (P<0.05).Conclusion After ERCP, pancreatic duct stenting combined with non-storied anti-inflammatory drug could reduce the rates of hyperamylasemia and PEP , as well as the scores of abdominal pain scores after ERCP, and also could effectively prevent the incidence of pancreatitis after PEP .