鼻胆管负压引流在急性梗阻性胆管炎ERCP术后的疗效评价  

Efficacy of negative pressure nasobiliary drainage in acute obstructive cholangitis after endoscopic retrograde cholangiography

作　　者：金雷 戴萌[2] 顿珊珊 吴娟 李蜀豫 

机构地区：[1]湖北省第三人民医院消化内科,湖北省武汉市430000 [2]中国人民解放军武汉总医院消化内科,湖北省武汉市430000

出　　处：《世界华人消化杂志》2017年第26期2394-2400,共7页World Chinese Journal of Digestology

摘　　要：目的评价急性梗阻性胆管炎经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)术后鼻胆管负压引流疗效及意义.方法选取180例急性结石性胆管炎患者行ERCP治疗,术后随机分为对照组及试验组;对照组行常规鼻胆管引流术(Endoscopic nasobiliary drainage,ENBD),试验组行ENBD负压引流,观察比较2组患者术后不同时刻各项监测指标的差异.结果 2组患者的性别、年龄、基础疾病等差异无统计学意义(P>0.05).(1)术后24、48、72 h试验组胆汁总引流量均显著高于对照组(P<0.05);(2)术后24、72 h试验组血清总胆红素、直接胆红素显著低于对照组(P<0.0 5).未出现术后胰腺炎(Post-endoscopicretrograde cholangiopancreatography pancreatitis,PEP)及高淀粉酶血症患者中,试验组C反应蛋白、降钙素原、肿瘤坏死因子-α、白介素-10水平显著低于对照组(P<0.05);(3)术后2、24 h试验组血清淀粉酶水平显著低于对照组(P<0.05);试验组术后胰腺炎PEP及高淀粉酶血症发生率(6.67%,6/90;10%,9/90)显著低于对照组(11.1%,10/90;17.18%,16/90)(P<0.05).2组患者术后均出现未出现重症胰腺炎.结论急性梗阻性胆管炎ERCP术后负压ENBD引流疗效确切,能更有效减轻胆管炎症,降低PEP及高淀粉酶血症的发生率,值得临床推广.AIM To evaluate the efficacy of negative pressure nasobiliary drainage in the management of acute obstructive cholangitis after endoscopic retrograde cholangiopancreatography （ERCP）.METHODS One hundred and eighty patients with acute obstructive cholangitis treated by ERCP were randomly divided into a control group and an experimental group. The control group was treated by conventional endoscopic nasobiliary drainage （ENBD）, while the experimental group was treated by ENBD with continuous negative pressure. The efficacy and safety were then compared between the two groups.RESULTS There was no significant difference in gender, age, or underlying disease between the two groups （P 〉 0.05）. All cases were operated successfully. The total amounts of biliary drainage at 24 h, 48 h, and 72 h after ERCP were significantly higher in the experimental group than in the control group （P 〈 0.05）. The levels of serum total bilirubin and direct bilirubin at 24 h and 72 h after ERCP were significantly lower in the experimental group than in the control group （P 〈 0.05）. The levels of C-reactive protein, procalitonin, TNF-a, and IL-10 at 24 h and 72 h after ERCP in patients without post-ERCP pancreatitis （PEP） and hyperamylasemia were significantly lower in the experimental group than in the control group （P 〈 0.05）. The levels of serum amylase at 2 h and 24 h after ERCP were significantly lower in the experimental group than in the control group （P 〈 0.05）. The incidence rates of PEP and hyperamylasemia in the experimental group （6.67%, 6/90; 10%, 9/90） were significantly lower than those in the control group （11.1%, 10/90; 17.18%, 16/90） （P 〈 0.05）. Severe PEP did not occur in either group.CONCLUSION ENBD with negative pressure suction in patients with acute obstructive cholangitis after ERCP can effectively alleviate cholangitis and reduce the incidence of PEP and hyperamylasemia.

关 键 词：急性梗阻性胆管炎 内镜逆行胰胆管造影术 鼻胆管引流 负压 术后胰腺炎 

分 类 号：R575.7[医药卫生—消化系统]