胰管支架在行内镜逆行胰胆管造影术的胆总管结石患者中的应用

Application of pancreatic stent in patients with calculus of common bile duct undergoing ERCP

摘要:

目的 分析胰管支架在行内镜逆行胰胆管造影术（ERCP）的胆总管结石患者中的应用效果。方法 采用前瞻性研究法，对2019年6月－2022年6月该院收治的100例胆总管结石患者展开研究，采用随机数表法，将其分为对照组和观察组，各50例。两组均采用ERCP治疗，观察组术中留置胰管支架。比较两组患者肝功能、炎症指标、血淀粉酶值、术后高淀粉酶血症、术后胰腺炎（PEP）、术后腹痛、住院情况和并发症发生情况。结果 与对照组相比，观察组术后7 d，谷丙转氨酶（GPT）、谷草转氨酶（GOT）、总胆红素（TBIL）、白细胞（WBC）、C反应蛋白（CRP）、降钙素原（PCT）水平降低，术后3和24 h血淀粉酶值降低，差异均有统计学意义（P < 0.05）；与对照组相比，观察组术后高淀粉酶血症、PEP、重症PEP和腹痛发生率降低，腹痛评分降低，术后恢复进食时间、术后体温恢复正常时间和术后住院时间缩短，术后并发症总发生率降低，差异均有统计学意义（P < 0.05）。结论 胆总管结石患者行ERCP，术中留置胰管支架，能够改善患者肝功能，减轻炎症反应，降低术后腹痛、高淀粉酶血症、PEP和并发症发生率，促进术后恢复。

Abstract:

Objective To analyze the application effect of pancreatic stents in patients underwent endoscopic retrograde cholangiopancreatography (ERCP) for calculus of common bile duct.Methods A prospective study was conducted on 100 patients with calculus of common bile duct from June 2019 to June 2022. They were randomly divided into control group and observation group with 50 patients each. ERCP was used in both groups, and pancreatic stents were retained in the observation group. The liver function, inflammatory index level, blood amylase value, the postoperative hyperamylasemia, post-ERCP pancreatitis (PEP), postoperative abdominal pain, hospitalization and complications of the two groups were compared.Results Compared with the control group, the levels of glutamic-pyruvic transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), total bilirubin (TBIL), white blood cells, C-reactive protein (CRP), procalcitonin (PCT) 7 d after operation, blood amylase values at 3 and 24 h after operation in the observation group decreased significantly (P < 0.05). The incidence of hyperamylasemia, PEP and severe PEP and the incidence of abdominal pain in observation group were decreased, the score of abdominal pain was decreased, the time to resume eating, the time to normalize body temperature and the time to stay in hospital were shortened, and the total incidence of complications in the observation group was decreased, the differences were statistically significant (P < 0.05).Conclusion In patients with calculus of common bile duct underwent ERCP, indwelling pancreatic stent can improve liver function, reduce inflammatory response, reduce the incidence of postoperative abdominal pain, hyperamylasemia, PEP and complications, and promote postoperative recovery.