胰管支架对伴有危险因素的患者发生ERCP术后胰腺炎的预防作用  

Effect of Prophylactic Pancreatic Duct Stenting on Post-ERCP Pancreatitis in Patients With Risk Factors

作　　者：贾国法 单红 吴丽颖 张迪 王金芝 王晓天 朱良松 

机构地区：[1]安徽省淮北市人民医院消化内科,235000

出　　处：《胃肠病学》2017年第9期548-552,共5页Chinese Journal of Gastroenterology

基　　金：安徽省淮北市科技计划项目(20140306)

摘　　要：背景:胰腺炎是ERCP的主要并发症,多个危险因素累加会增加发生风险。研究显示临时胰管支架可降低ERCP术后胰腺炎(PEP)发生率。目的:探讨胰管支架置入预防伴有危险因素的患者发生PEP的有效性和安全性。方法:选取2013年11月—2016年11月安徽省淮北市人民医院接受ERCP且具备1项及以上PEP相关危险因素的患者,随机分为胰管支架置入组(观察组)和未置入胰管支架组(对照组)。比较两组患者术后4 h、24 h、48 h血淀粉酶水平和PEP发生率。结果:共297例患者纳入研究,其中观察组147例,对照组150例。两组患者性别、年龄和ERCP疾病谱等均无明显差异(P>0.05)。观察组PEP发生率显著低于对照组(6.1%对16.0%,P<0.05),术后4 h、24 h、48 h血清淀粉酶水平显著低于相应对照组(P<0.05),但两组术后高淀粉酶血症发生率无明显差异(59.2%对54.7%,P>0.05)。结论:预防性胰管支架置入可降低伴有PEP危险因素患者的PEP发生率,尤其可降低PEP的严重程度,但高淀粉酶血症的发生率并未下降。Background： Pancreatitis is the main complication of ERCP,and a variety of risk factors will increase its risk.Studies showed that temporary pancreatic duct stent can reduce the incidence of post-ERCP pancreatitis（ PEP）. Aims： To study the efficacy and safety of prophylactic pancreatic duct stenting on preventing PEP in patients with risk factors.Methods： Patients undergone ERCP and accompanied with one or more PEP-associated risk factors from November 2013 to November 2016 at Huaibei People＇s Hospital were enrolled,and were divided randomly into pancreatic duct stenting group（ observation group） and non-stenting group（ control group）. Serum levels of amylase at 4,24 and 48 hours after the procedure and incidence of PEP were compared between the two groups. Results： A total of 297 patients were enrolled,and 147 patients were in observation group,and 150 patients in control group. No significant differences in gender,age and ERCP disease spectrum were found between the two groups（ P〈0. 05）. Incidence of PEP was significantly decreased in observation group than in control group（ 6. 1% vs. 16. 0%,P〈0. 05）. Serum levels of amylase at 4,24 and 48 hours after the procedure were significantly decreased in observation group than in corresponding control group（ P〈0. 05）,however,no significant difference in incidence of hyperamylasemia was found between the two groups（ 59. 2% vs. 54. 7%,P〈0. 05）. Conclusions： Prophylactic pancreatic duct stenting may decrease the incidence of PEP in patients accompanied with PEP-associated risk factors, especially could decrease the severity of PEP. However, the incidence of hyperamylasemia is not decreased.

关 键 词：胰胆管造影术 内窥镜逆行 支架 ERCP术后胰腺炎 高淀粉酶血症 危险因素 

分 类 号：R576[医药卫生—消化系统]