经鼻胆管留置胰管导丝预防细径胰管胆囊结石和胆总管结石患者ERCP术后胰腺炎的疗效观察  

Observation on the preventive effect of indwelling pancreatic duct guide wire through nasobiliary drainage tube for post-ERCP pancreatitis in cholelithiasis patients with small-caliber pancreatic duct

作　　者：黄安华[1] 张诚 杨玉龙 胡海[1] 蔡景理[1] 何川琦[1] Huang Anhua;Zhang Cheng;Yang Yulong;Hu Hai;Cai Jingli;He Chuanqi(Cholelithiasis Center,Shanghai East Hospital Affiliated to Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院胆石病中心,上海200120

出　　处：《中华肝胆外科杂志》2023年第12期892-896,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：上海市浦东新区卫生系统重点专科建设项目(PWZzk2022-17);浦东新区临床特色学科基金(PWYts2021-06);上海市东方医院临床研究项目(DFLC2022019)。

摘　　要：目的探讨经鼻胆管留置胰管导丝预防细径胰管胆囊结石和胆总管结石患者内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)的疗效。方法回顾性分析2019年1月至2023年6月在同济大学附属东方医院胆石病中心行ERCP取石序贯腹腔镜胆囊切除术(LC)的127例胆囊结石和胆总管结石患者的临床资料,其中男性55例,女性72例,年龄(56.95±10.86)岁。依照预防PEP的方法,将127例患者分为3组:经鼻胆管留置胰管导丝预防PEP的患者为导丝组(n=45);采用鼻胆管+单猪尾胰管支架(5 Fr 5 cm)预防PEP的患者为支架组(n=59);采用常规鼻胆管预防PEP的患者为常规预防组(n=23)。比较各组患者ERCP术后高淀粉酶血症(PEH)及PEP的发生情况。结果导丝组PEH发生率低于常规预防组[17.8%(8/45)比43.5%(10/23)],差异有统计学意义(P=0.023);导丝组PEH发生率低于支架组[17.8%(8/45)比32.2%(19/59)],但差异无统计学意义(P=0.337);支架组PEH发生率低于常规预防组[32.2%(19/59)比43.5%(10/23)],但差异无统计学意义(P=0.096)。导丝组PEP发生率低于支架组[6.7%(3/45)比23.7%(14/59)],差异有统计学意义(P=0.030);导丝组PEP发生率低于常规预防组[6.7%(3/45)比30.4%(7/23)],差异有统计学意义(P=0.025);支架组PEP发生率低于常规预防组[23.7%(14/59)比30.4%(7/23)],但差异无统计学意义(P=0.532)。结论与预防性胰管支架相比,经鼻胆管留置胰管导丝能有效预防细径胰管胆囊结石和胆总管结石患者PEH及PEP的发生。Objective To evaluate the preventive effect of indwelling pancreatic duct guide wire through nasobiliary drainage catheter for post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)in cholelithiasis patients with small-caliber pancreatic duct.Methods The clinical data of 127 patients with gall bladder and common bile duct stones undergoing ERCP and elective laparoscopic cholecystectomy in the Cholelithiasis Center of Shanghai East Hospital Affiliated to Tongji University from January 2019 to June 2023 were analyzed retrospectively,including 55 males and 72 females,aged(56.95±10.86)years old.According to the preventive methods of PEP,patients were divided into the guide wire group(indwelling pancreatic duct guide wire through nasobiliary drainage catheter),stenting group(nasobiliary catheter with 5Fr 5 cm single pigtail pancreatic duct stent)and conventional group(nasobiliary catheter).The incidence of post-ERCP hyperamylasemia(PEH)and PEP were compared.Results The incidence of PEH in the guide wire group was lower than that in the conventional group[17.8%(8/45)vs.43.5%(10/23),P=0.023],and also lower than that in the stenting group[17.8%(8/45)vs.32.2%(19/59)],despite no statistical significance(P=0.337).The incidences of PEH were comparable in the stenting group and conventional group[32.2%(19/59)vs.43.5%(10/23),P=0.096)].The incidence of PEP in the guide wire group was lower than that in both the stenting group[6.7%(3/45)vs.23.7%(14/59),P=0.030].and conventional group[6.7%(3/45)vs.30.4%(7/23),P=0.025].The incidences of PEP were comparable in the stenting and conventional group[23.7%(14/59)vs.30.4%(7/23),P=0.532].Conclusion Compared to the preventive pancreatic duct stenting,indwelling pancreatic duct guide wire through nasobiliary drainage catheter can effectively prevent the PEH and PEP in high-risk patients with a small-caliber pancreatic duct.

关 键 词：胰腺炎 内镜逆行胰胆管造影 高淀粉酶血症 胰管支架 

分 类 号：R576[医药卫生—消化系统]