不同剂量甘露醇十二指肠乳头局部喷洒预防内镜逆行胰胆管造影术后胰腺炎的疗效评价

Efficacy evaluation of local spray of different doses of mannitol on the duodenal papilla for preventing pancreatitis after endoscopic retrograde cholangiopancreatography

摘要:

目的 评估不同剂量甘露醇喷洒于十二指肠乳头局部，预防内镜逆行胰胆管造影术（ERCP）后胰腺炎的临床疗效及安全性。方法 回顾性分析2020年1月－2024年10月该院消化内科收治的138例成功完成ERCP的患者的临床资料。根据手术结束前喷洒不同剂量甘露醇，将患者分为4组：D1组（33例）喷洒20 mL 20%甘露醇溶液，D2组（37例）喷洒60 mL 20%甘露醇溶液，D3组（33例）喷洒100 mL 20%甘露醇溶液，C组（对照组，35例）未喷洒任何液体。比较4组患者术前12 h、术后12 h、术后24 h和术后48 h的白细胞（WBC）、C反应蛋白（CRP）和淀粉酶（AMS）水平变化情况；评估4组患者术后高淀粉酶血症（PEHA）和术后胰腺炎（PEP）的发生率，以及不良反应发生情况。结果 术前12 h，4组间WBC、CRP和AMS水平比较，差异均无统计学意义（P > 0.05）。术后12、24和48 h，D2组和D3组同时点WBC、CRP和AMS水平明显低于C组和D1组，差异均有统计学意义（P < 0.05）；D2组与D3组、C组与D1组同时点组间WBC、CRP和AMS水平比较，差异均无统计学意义（P > 0.05）。术后，D2组和D3组PEHA发生率分别为：21.6%（8/37）和18.2%（6/33），明显低于C组的48.6%（17/35）和D1组的45.5%（15/33），差异均有统计学意义（P < 0.05）；D2组和D3组PEP发生率分别为：2.7%（1/37）和3.0%（1/33），低于C组的11.4%（4/35）和D1组的9.1%（3/33），但4组间比较，差异无统计学意义（P > 0.05）。术后，D3组不良反应总发生率为45.5%（15/33），明显高于其他3组，差异有统计学意义（P < 0.05）；D2组不良反应总发生率为8.1%（3/37），但与C组和D1组比较，差异无统计学意义（P > 0.05）。结论 ERCP结束前于十二指肠乳头局部喷洒甘露醇60和100 mL，均能明显降低患者术后WBC、CRP、AMS水平和PEHA发生率，且对PEP具有一定的预防作用，而60 mL为更优剂量选择，不良反应少，且安全性高。

Abstract:

Objective To evaluate the clinical efficacy and safety of spraying different doses of mannitol locally on the duodenal papilla in preventing pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).Methods A retrospective analysis was conducted on the clinical data of 138 patients who successfully completed ERCP from January 2020 to October 2024. According to the different doses of mannitol sprayed before the end of the operation, the patients were divided into 4 groups: group D1 (33 cases) was sprayed with 20 mL of 20% mannitol solution, group D2 (37 cases) was sprayed with 60 mL of 20% mannitol solution, group D3 (33 cases) was sprayed with 100 mL of 20% mannitol solution, and group C (35 cases) was not sprayed with any liquid. The changes in the levels of white blood cells (WBC), C-reactive protein (CRP), and amylase (AMS) of the four groups of patients at 12 hours before surgery, 12 hours after surgery, 24 hours after surgery, and 48 hours after surgery were compared. To evaluate the incidence of postoperative hyperamylasemia (PEHA) and postoperative pancreatitis (PEP), as well as the occurrence of adverse reactions in the four groups of patients.Results At 12 hours before the operation, there were no statistically significant differences in the levels of WBC, CRP and AMS among the four groups (P > 0.05). At 12, 24 and 48 hours after the operation, the levels of WBC, CRP and AMS at the same time points in group D2 and group D3 were significantly lower than those in group C and group D1, and the differences were statistically significant (P < 0.05). There were no statistically significant difference in the levels of WBC, CRP and AMS at the same time points between group D2 and group D3, and between group C and group D1 (P > 0.05). After the operation, the incidence rates of PEHA in group D2 and group D3 were 21.6% (8/37) and 18.2% (6/33) respectively, which were significantly lower than 48.6% (17/35) in group C and 45.5% (15/33) in group D1. The differences were statistically significant (P < 0.05). The incidence rates of PEP in group D2 and group D3 were 2.7% (1/37) and 3.0% (1/33) respectively, which were lower than 11.4% (4/35) in group C and 9.1% (3/33) in group D1. However, there was no statistically significant difference among the four groups (P > 0.05). After the operation, the total incidence of adverse reactions in group D3 was 45.5% (15/33), which was significantly higher than that in the other three groups, and the difference was statistically significant (P < 0.05). The total incidence of adverse reactions in group D2 was 8.1% (3/37), but compared with group C and group D1, the difference was not statistically significant (P > 0.05).Conclusion Local spraying of 60 mL and 100 mL of mannitol on the duodenal papilla before the end of ERCP can significantly reduce the levels of WBC, CRP, and AMS in patients after surgery, as well as the incidence of PEHA, and has a certain preventive effect on PEP. The 60 mL dose is a better choice with fewer adverse reactions and is safe.