摘要
目的探讨胰管塑料支架结合鼻胆管引流对复杂、难治性胆总管结石患者内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)及高淀粉酶血症的预防作用。方法选择2016年1月-2018年4月于淄博市中心医院消化内镜中心经ERCP治疗的113例复杂、难治性胆总管结石患者,采用随机数字表法随机分成2组,对照组(57例)仅在ERCP胆总管取石术后行鼻胆管引流,支架组(56例)行胰管插管留置导丝后常规胆管插管、胆管取石术后置入胰管支架、鼻胆引流管。比较2组患者在ERCP术后结石清除率、胰腺炎及严重程度、高淀粉酶血症发生率以及术后患者腹痛评分结果。结果对照组57例患者,结石完全清除47例(82.46%),PEP 10例(17.54%),重症PEP2例(3.51%),高淀粉酶血症15例(26.32%),术后患者腹痛评分(4.33±1.09)分;支架组56例患者,结石完全清除45例(80.36%),PEP 3例(5.36%),无重症PEP,高淀粉酶血症6例(10.71%),术后患者腹痛评分为(3.56±1.37)分。支架组ERCP术后PEP、高淀粉酶血症及术后腹痛评分明显少于对照组(均P<0.05),结石完全清除率、重症PEP发生率差异无统计学意义(均P>0.05)。结论复杂、难治性胆总管结石患者ERCP治疗术后可通过放置胰管支架和鼻胆管引流减少术后PEP、高淀粉酶血症的发生,减轻患者腹痛程度,但对结石清除率、重症PEP发生率无明显影响。
Objective To investigate the application and value of pancreatic stents combing nasal biliary tube(NBT) after Endoscopic Retrograde Cholangiopancreatography(ERCP) for removal of difficult and large common bile duct stones and its prevention of pancreatitis and hyperamylasemia. Methods From January 2016 to April 2018 a total of 113 patients who had difficult and large common bile duct stones received ERCP procedure in endoscopy center of Zibo Central hospital. They were randomized to non-stent group(NS group), who receive nasal biliary tube(NBT) placement after ERCP procedure, and stent group(S group). Patients in the stent group were treated with pancreatic stent and NBT placement after the conventional ERCP procedure. The successful stone clearance rate, incidence of post-ERCP pancreatitis(PEP), pancreatitis severity rating, hyperamylasemia and scores of abdominal pain were analyzed using t test and χ~2 test. Results Of the 57 patients in NS group, 47 achieved successful stone clearance(82.46%), 10 cases PEP(17.54%), 2 severe PEP and 15 cases hyperamylasemia(26.32%). The score of abdominal pain was(4.33±1.09). There were 56 patients in S group, 45 cases(80.36%) achieved successful stone clearance, PEP and hyperamylasemia were 3 cases and 6 cases respectively(5.36%,10.71%), and no severe PEP was observed in S group.The score of abdominal pain was(3.56±1.37). There was no significant difference in the successful clearance rate and the incidence of severe PEP between the two groups(all P>0.05), while PEP, the hyperamylasemia and the scores of abdominal pain were lower in the S group(all P<0.05). Conclusion For patients with difficult and large common bile duct stones, placement of pancreatic duct stent with NBT after ERCP can reduce PEP, the hyperamylasemia and score of abdominal pain, but do not have significant influence on successful clearance rate and the incidence of severe PEP.
作者
陶涛
张明
张启杰
李明东
李桂花
唐丙喜
朱萧
TAO Tao;ZHANG Ming;ZHANG Qi-jie(The Second Department of Gastroenterology,Zibo Central Hospital,Zibo,Shandong 255000,China)
出处
《中华全科医学》
2019年第9期1439-1442,共4页
Chinese Journal of General Practice
基金
国家自然科学基金项目(81541153)
关键词
胰腺炎
高淀粉酶血症
内镜逆行胰胆管造影
胰管支架
并发症
Pancreatitis
Hyperamylasemia
Endoscopic retrograde cholangiopancreatography
Pancreatic duct stent
Complication
