吲哚美辛联合鼻胆管低负压引流在预防ERCP术后胰腺炎的效果分析  

Efficacy of indomethacin combined with negative pressure nasobiliary drainage in the prevention of post-ERCP pancreatitis

作　　者：曹钰 蒋辉 张瑜[2] 丁兵[2] 凌俊[2] Cao Yu;Jiang Hui;Zhang Yu;Ding Bing;Ling Jun(Department of Hepatobiliary Pancreatic Surgery,The Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院肝胆胰外科,四川泸州646000 [2]内江市第二人民医院肝胆胰外科

出　　处：《腹部外科》2018年第6期428-432,共5页Journal of Abdominal Surgery

摘　　要：目的探讨内镜下逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)在术前经直肠给予吲哚美辛及术后使用鼻胆管低负压引流对预防ERCP术后胰腺炎(postERCP pancreatitis,PEP)发生的作用。方法选取内江市第二人民医院2015年7月至2017年9月期间行ERCP治疗的胆总管结石病人188例,随机分为三组:A组(吲哚美辛+鼻胆管低负压引流组,63例)、B组(吲哚美辛+鼻胆管常规引流组,63例)、C组(安慰剂+鼻胆管常规引流组,62例),观察分析三组病人术后不同时刻各项监测指标的差异。结果 A组与B、C组相比,ERCP术后第24、48小时鼻胆管胆汁引流量更多、血清胆红素水平下降更快,鼻胆管发生堵塞例数更少(均P<0.05)。A组、B组ERCP术后第6、24、48小时血清淀粉酶、WBC、C反应蛋白水平均显著低于C组(均P<0.05),其中A组比B组更低(P<0.05)。A组(3.17%)PEP发生率低于B组(12.70%)、C组(16.13%),且差异均有统计学意义(均P<0.05)。A组、B组与C组相比,腹痛、腹胀消失时间及住院时间均明显缩短,其中A组恢复时间最快、住院时间最短(均P<0.05)。三组PEP病人中均无重型胰腺炎。结论吲哚美辛联合鼻胆管低负压引流方便、经济、安全,可更有效地降低PEP发生率,具有良好的临床应用前景。Objective To investigate the value of indomethacin combined with negative pressure nasobiliary drainage in the prevention of post-endoscopic retrograde cholangio-pancreatography(ERCP)pancreatitis(PEP).Methods From July 2015 to September 2017,188 cases of common bile duct stones treated by ERCP were addressed in our department.Patients were randomized into group A(indomethacin+ negative pressure nasobiliary drainage),group B(indomethacin+conventional pressure nasobiliary drainage)and group C(placebo+conventional pressure nasobiliary drainage).The differences in the monitoring indicators among the three groups were observed.Results Group A had the most bile drainage,the fastest decrease of bilirubin level and the least obstruction of nasobiliary duct at24 hand 48 hafter ERCP in the three groups(P < 0.05).The levels of serum amylase,WBC count and CRP in group A and group B were significantly lower than those in group C at 6 h,24 hand 48 h after ERCP(P<0.05),and those in group A were significantly lower than in group B(P<0.05).The incidence of PEP in group A(3.17%)was significantly lower than that in group B(12.70%)and group C(16.13%)(P<0.05 for all).The sustained time of abdominal pain and abdominal distention,and hospital stay in group A and group B were shorter than those in group C.The time of recovery was fastest and hospital stay was shortest in group A(P <0.05).There were no severe pancreatitis in patients with PEP.Conclusions Indomethacin combined with negative pressure nasobiliary drainage is convenient,economical and safe.This measure can reduce the incidence of PEP more effectively,and has a good prospect of clinical application.

关 键 词：吲哚美辛 鼻胆管低负压引流 胰腺炎 疗效 

分 类 号：R657.51[医药卫生—外科学]