胰管置管预防十二指肠乳头球囊扩张术并发胰腺炎的临床价值  

Clinical value of catheter in pancreatic duct for prevention of post-EPBD pancreatitis

作　　者：胡亦懿[1] 杜国平[1] 王鹏[1] 李国华[1] 谢运铮 

机构地区：[1]广东省佛山市顺德第一人民医院消化科,528300

出　　处：《中华消化内镜杂志》2015年第5期296-299,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨术前胰管置管在预防十二指肠乳头球囊扩张（endoscopic papillary balloon dilation，EPBD）术后并发胰腺炎的临床应用价值。方法选取43例确诊为胆总管结石且血淀粉酶正常的患者行EPBD治疗，23例为试验组，术前行胰管内预防性置管（ERCP造影管），将乳头球囊扩张至10mm后行胆管取石术；20例为对照组，用直径为8mm的球囊扩张乳头后取石。比较患者术前、术后6h、术后24h血淀粉酶（sAMS）水平，分析2组胰腺炎及高淀粉酶血症发生情况。同时比较2组取石时间及取石的成功率。结果试验组EPBD术后发生胰腺炎1例（4．35％），对照组发生胰腺炎7例（35．00％），2组差异有统计学意义（P〈0．05）；试验组术后6h、术后24h sAMS值分别为（102．61±98．99）U／L及（60．35±26．18）U／L，均低于对照组（398．25±259．32）U／L及（230．50±281．31）U／L（P〈0．05）。对照组平均取石时间为（17．90±4．49）min，试验组将乳头球囊扩张至10mm后，平均取石时间为（10．43±2．27）min，较对照组缩短，差异有统计学意义（P〈0．05）。取石成功率2组无差异，均一次取石成功。结论EPBD术前胰管内放置ERCP造影管，内镜下胆管取石更顺利，操作时间缩短，可有效预防EPBD术后胰腺炎及高淀粉酶血症。Objective To evaluate catheterization in pancreatic duct before endoscopic papillary bal- loon dilation （EPBD） to prevent pancreatitis after EPBD. Methods Forty-three patients with normal serum amylase levels, diagnosed as having bile duct stones, underwent EPBD. Twenty-three were assigned to experimental group, where catheters（ ERCP imaging tube）were placed in pancreatic duct before EPBD, then the papillary balloon was expanded to 10 mm. Twenty were assigned to control group where eight-millimeter-diameter papillary balloon was used to remove the stones. The serum amylase levels before EPBD, 6 hours and 24 hours after EPBD, the incidence of pancreatitis and high serum amylase levels associated with EPBD, as well as the mean time and success rate of removing the stones of the two groups were compared. Results Post-EPBD pancreatitis occurred in one patient in experimental group （4. 35%）, and seven in control group （35.00%）, which was significantly different（P 〈0. 05）. Meanwhile, the mean levels of serum amylase 6 h and 24 h after EPBD in the experimental group were （102. 61 ±98.99） U/L and （60. 35 ±26. 18） U/L respectively, lower than those in the control group （398. 25 ± 259. 32） U/L and （230. 50 ± 281.31 ） U/L（ P 〈 0. 05 ）. After the papillary balloon was expanded to 10 mm in experimental group, the mean time of removing stones was （ 10. 43 ± 2. 27 ） rnin, which was shorter than that of control group （ 17.90 ± 4. 49 ） min （ P 〈 0. 05 ）. Stone-removing rate of two groups had no difference and they all succeeded one time. Conclusion Placing catheter in pancreatic duct before EPBD to prevent pancreatitis after EPBD makes it easier to remove stones in shorter operation time. It can prevent pancreatitis and high amylase blood disease after EPBD.

关 键 词：胰管 十二指肠球囊扩张术 预防 胰腺炎 

分 类 号：R656[医药卫生—外科学]