胰管支架置入术对经内镜逆行胰胆管造影术中反复胰管导丝插入患者术后胰腺炎的预防作用观察

Impact of pancreatic stent as a preventive measure on post-ERCP pancreatitis in patients with repeatedly non-selective pancreatic duct cannulation

摘要:

目的??探讨胰管支架置入术对经内镜逆行胰胆管造影术（ERCP）中反复胰管导丝插入患者术后胰腺炎（PEP）的预防作用。方法?前瞻性分析该院2008年1月-2015年12月收治的因插管困难而导致导丝反复进入胰管的胆道疾病患者64例，随机均分成观察组和对照组。皆常规行ERCP术，观察组术中置入胰管支架，对照组术后不置入胰管支架或者鼻胰管，术后监测腹痛症状，血淀粉酶。统计并对比分析两组急性胰腺炎的发生率、胰腺炎严重程度分级、腹痛评分、Ranson评分、淀粉酶恢复时间。结果?观察组发生5例PEP，发生率为15.6%，其中轻型4例（12.5%）、中型1例（3.1%）；对照组发生13例PEP，发生率为40.6%，其中轻型6例（18.8%）、中型4例（12.5%）、重型3例（9.4%）。观察组PEP发生率明显低于对照组（P <0.05）。轻、中、重型PEP发生率均低于对照组，其中中、重型PEP发生率明显低于对照组（P <0.05）。观察组术后Ranson评分为（1.2±0.4）分，明显低于对照组的（2.5±1.2）分（P <0.05）；观察组淀粉酶恢复正常时间平均为（3.0±0.6）d，亦明显低于对照组的（5.8±1.4）d（P <0.01）。两组皆未发生出血和穿孔等并发症。结论?应用胰管支架置入能够有效预防因导丝反复进入胰管患者的PEP的发生率、减轻患者术后痛楚、促进患者恢复。

Abstract:

Objective?To investigate the impact of pancreatic duct stenting as a preventive measure for post-ERCP pancreatitis in patients with repeatedly non-selective pancreatic duct cannulation.?Methods?Clinical data of 64 patients with biliary tract disease from January 2008 to December 2015 was prospective analyzed. All the patients were randomly divided into observation group and control group. Patients in observation group received pancreatic stent placement, while patients in control group was not received pancreatic stent placement and nasal duct. Postoperative monitoring items included abdominal pain, blood amylase. Then record and compare the incidence of acute pancreatitis, pancreatitis severity rating, abdominal pain score, Ranson score, amylase recovery time between the two groups.?Results?Observation group had five cases of PEP, the rate was 15.6 %, including mild four cases (12.5 %), medium one case (3.1 %); the control group had 13 cases of PEP, the rate was 40.6 %, including mild six cases (18.8 %), medium four cases (12.5 %), severe three cases (9.4 %). PEP observation group was significantly lower than the control group (P < 0.05). Mild, medium and severe PEP were lower than the control group, in which the severe PEP was significantly lower than the control group (P < 0.05). Ranson score of the observation group was (1.2 ± 0.4), significantly lower than the control group (2.5 ± 1.2) (P < 0.05); the observation group amylase average recovery time was (3.0 ± 0.6) d, it is also significantly lower than the control group (5.8 ± 1.4) d (P < 0.01). No bleeding and perforation complications occurred.?Conclusion?Pancreatic stenting can effectively prevent the incidence of PEP, reduce postoperative pain, improve patient recovery.