ERCP取石后胆道引流胰管支架置入时机对效果及安全性的影响  

Effects of stent placement timing on the efficacy and safety of patients undergoing biliary drainage with pancreatic duct stents after ERCP lithotomy

作　　者：韩敏 赵海明 才新 王志华 HAN Min;ZHAO Hai-ming;CAI Xin;无(Qinghai Red Cross Hospital Gastroenterology Department,Qinghia 810000;Qinghai Red Cross Hospital Emergency Department Xining,Qinghia 810000;Affliated Hospital of Qinghai University,Xining,Qinghai 810001,China)

机构地区：[1]青海红十字医院消化内科,西宁810000 [2]青海红十字医院急诊科,西宁810000 [3]青海大学附属医院,810001

出　　处：《肝胆外科杂志》2024年第6期449-452,480,共5页Journal of Hepatobiliary Surgery

基　　金：青海省科技计划项目(2021 ZJ723)。

摘　　要：目的分析内镜逆行胰胆管造影(ERCP)取石后胆道引流胰管支架置入时机对效果及安全性的影响。方法选取青海红十字医院消化内科收治行ERCP术的86例胆总管结石患者,时间范围为2022年1月至2024年1月,根据患者选择不同取石方案分为研究组和对照组,各43例。研究组在胆总管插管成功后给予置入胰管支架,并进行取石,对照组在胆总管插管成功后先取石,结石取尽后给予置入胰管支架。比较两组炎症因子水平[C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、血淀粉酶值,评估两组手术指标、术后并发症发生率。结果与治疗前相比,治疗后两组CRP、PCT、TNF-α、IL-6水平降低,且研究组更低(P<0.05)。与术后3 h比较,两组术后12 h、24 h血淀粉酶值均降低(P<0.05);与术后12 h比较,两组术后24 h血淀粉酶值降低(P<0.05);与对照组比较,研究组术后12 h、术后24 h血淀粉酶值更低(P<0.05)。与对照组比较,研究组腹痛消失时间、术后住院时间、术后体温恢复时间、术后恢复进食时间均更短(P<0.05)。研究组术后并发症总发生率为11.63%,低于对照组的32.56%(P<0.05)。结论采用ERCP取石后行胆道引流早期置入胰管支架治疗胆总管结石患者能够显著降低炎症因子水平,改善血清淀粉酶水平及术后并发症的发生率,有利于促进患者病情恢复。Objective To analyze the effect and safety of stent placement for biliary drainage and pancreatic duct after endoscopic retrograde cholangiopancreatography(ERCP).Methods A total of 86 patients with choledocholithiasis who underwent ERCP were selected from the department of gastroenterology,Qinghai Red Cross Hospital from January 2022 to January 2024.They were divided into study group and control group by different lithotomy schemes are selected according to the patient,43 cases in each group.The research group implanted pancreatic duct stent and carried out stone extraction after successful choledochal catheterization.In the control group,stone was removed after successful choledochal catheterization,and pancreatic duct stent was implanted after stone removal.The levels of inflammatory factors^([C-reactive protein(CRP),procaleitonin(PCT),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)])and blood amylase were compared between the two groups.The operative indexes and postoperative complication rate of the two groups were evaluated.Results Compared with before treatment,the levels of CRP,PCT,TNF-αand IL-6 were decreased in the two groups after treatment,and the levels were lower in the research group(P<0.05).Compared with 3 hours after surgery,both groups showed a decrease in blood amylase levels at 12 and 24 hours after surgery(P<0.05).Compared with 12 h after surgery,the blood amylase value at 24 h after surgery was decreased in both groups(P<0.05).Compared with the control group,the blood amylase value of the research group was lower at 12 h and 24 h after surgery(P<0.05).Compared with the control group,the time for abdominal pain to disappear,the time for postoperative hospitalization,the time for postoperative temperature recovery and the time for postoperative food recovery were shorter in the research group(P<0.05).The total incidence of postoperative complications was 11.63%in the research group,which was lower than 32.56%in the control group(P<0.05).Conclusion In the treatment of patients with choledo

关 键 词：内镜下逆行胰胆管造影术 胰管支架 引流术 胆总管结石 安全性 

分 类 号：R657.4[医药卫生—外科学]