ERCP导丝非选择性进入胰管后胰管支架置入对术后胰腺炎的预防效果  

The protective effects of pancreatic duct stenting in preventing post-ERCP pancreatitis among patients with non-selective pancreatic cannulation

作　　者：王佐正[1] 姚维杰 黎明[1] 宋建军[1] 王娜[1] 陈红[1] 雍莉[1] WANG Zuozheng;YAO Weijie;LI Ming;SONG Jianjun;WANG Na;CHEN Hong;YONG Li(Hepatobiliary Department,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院肝胆外科,宁夏银川750004

出　　处：《宁夏医学杂志》2018年第12期1089-1092,共4页Ningxia Medical Journal

基　　金：宁夏科技支撑计划项目(2015KJHM40);宁夏银川市科技计划资助项目(2014299)

摘　　要：目的探讨胰管支架置入在内镜逆行胰胆管造影术(ERCP)中导丝非选择性进入胰管对术后胰腺炎(PEP)的预防效果。方法选取因胆道疾病接受治疗性ERCP术,术中导丝非选择性进入胰管患者作为研究对象,依据术中是否放置胰管支架分为胰管支架组(PS组)和无支架组(NS组),比较2组术后24 h血清淀粉酶水平、术后24 h腹痛程度、术后住院天数、住院总费用以及高淀粉酶血症、急性胰腺炎的发生率。结果此研究共纳入患者190例,其中PS组97例,NS组93例。PS组患者术后24 h血清淀粉酶值为(94. 00±268. 00) U/L,高淀粉酶血症8例(8. 2%),PEP 2例(2. 1%),均为轻度PEP;住院总费用为(3. 45±1. 51)万元,术后24 h腹痛评分为(2. 00±1. 00)分,术后住院为(4. 00±3. 00) d。NS患者组术后24 h血清淀粉酶值为(144. 00±246. 00) U/L,高淀粉酶血症17例(18. 3%),PEP 8例(8. 6%),其中轻度PEP 5例、中度PEP 2例、重度PEP 1例;住院总费用为(3. 03±1. 17)万元,术后24 h腹痛评分为(2. 00±1. 00)分,术后住院为(4. 00±4. 00) d。PS组ERCP术后24 h血清淀粉酶值、高淀粉酶血症发生率、PEP发生率均低于NS组患者,差异有统计学意义(P <0. 05);住院总费用PS组高于NS组,差异有统计学意义(P <0. 05); 2组患者ERCP术后24 h腹痛评分、术后住院天数比较差异无统计学意义(P>0. 05)。结论胰管支架置入可降低ERCP术中导丝非选择性进入胰管者术后PEP及术后高淀粉酶血症的发生率,可作为该人群PEP的预防手段。Objective To investigate whether pancreatic ductstenting has a protective role in preventing post-ERCP pancreatitis( PEP) among patients who underwent non-selective pancreatic cannulation. Methods Patients with biliary disease who underwent non-selective pancreatic cannulation in ERCP treatment were involved. They were grouped into pancreatic stent group( PS) and non-stent group( NS) according to whether pancreatic duct stenting were performed. Serum amylase level and abdominal pain score 24 hours after operation,hospital days,total cost,incidence of hyperamylasemia and acute pancreatitis after ERCP were compared between the two groups. Results A total of 190 patients were enrolled in this study,including 97 in PS group and 93 in NS group. In PS group,average blood amylase value 24 hours after operation was( 94. 00 ± 268. 00) U/L. Eight postoperative hyperamylasemia and 2 mild PEP were found in PS group. The average total cost was( 34. 50 ± 15. 10) thousand yuan and the average abdominal pain score was( 2. 00 ±1. 00) points. The average hospital stay were( 4. 00 ± 3. 00) days. In NS group,average blood amylase value 24 hours after operation was( 144. 00 ± 246. 00) U/L. Seventeen cases of postoperative hyperamylasemia( 18. 3%) and 8 cases of PEP( 8. 6%),including 5 cases of mild,2 cases of moderate and 1 case of severe PEP,were found in NS group. The average total cost was( 30. 30 ± 11. 70) thousand yuan. The average abdominal pain score was( 2. 00 ± 1. 00). The average hospital stay were( 4. 00 ± 4. 00) days. The average blood amylase value 24 hours after operation,incidence of PEP and postoperative hyperamylasemia were significantly higher in NS group( P < 0. 05). However,PS group had a higher treatment cost( P < 0. 05). There was no significant difference in abdominal pain score and hospitalization days between the two groups( P > 0. 05). Conclusion Pancreatic duct stenting has a protective role in preventing PEP and postoperative hyperamylasemia among patients who underwent non-selective pancreatic can

关 键 词：胰胆管造影术 胰管支架 支架置入 

分 类 号：R735.8[医药卫生—肿瘤]