胰管支架對伴有危險因素的患者發生ERCP術后胰腺炎的預防作用*

賈國法 單 紅 吳麗穎 張 迪 王金芝 王曉天 朱良松

安徽省淮北市人民醫院消化內科(235000)

胰管支架對伴有危險因素的患者發生ERCP術后胰腺炎的預防作用*

賈國法#單 紅 吳麗穎 張 迪 王金芝 王曉天 朱良松

安徽省淮北市人民醫院消化內科(235000)

背景：胰腺炎是ERCP的主要并發癥，多個危險因素累加會增加發生風險。研究顯示臨時胰管支架可降低ERCP術后胰腺炎(PEP)發生率。目的：探討胰管支架置入預防伴有危險因素的患者發生PEP的有效性和安全性。方法：選取2013年11月—2016年11月安徽省淮北市人民醫院接受ERCP且具備1項及以上PEP相關危險因素的患者，隨機分為胰管支架置入組(觀察組)和未置入胰管支架組(對照組)。比較兩組患者術后4 h、24 h、48 h血淀粉酶水平和PEP發生率。結果：共297例患者納入研究，其中觀察組147例，對照組150例。兩組患者性別、年齡和ERCP疾病譜等均無明顯差異(P>0.05)。觀察組PEP發生率顯著低于對照組(6.1%對16.0%，P<0.05)，術后4 h、24 h、48 h血清淀粉酶水平顯著低于相應對照組(P<0.05)，但兩組術后高淀粉酶血癥發生率無明顯差異(59.2%對54.7%，P>0.05)。結論：預防性胰管支架置入可降低伴有PEP危險因素患者的PEP發生率，尤其可降低PEP的嚴重程度，但高淀粉酶血癥的發生率并未下降。

胰膽管造影術, 內窺鏡逆行； 支架； ERCP術后胰腺炎； 高淀粉酶血癥； 危險因素

Background: Pancreatitis is the main complication of ERCP, and a variety of risk factors will increase its risk. Studies showed that temporary pancreatic duct stent can reduce the incidence of post-ERCP pancreatitis (PEP).Aims: To study the efficacy and safety of prophylactic pancreatic duct stenting on preventing PEP in patients with risk factors.Methods: Patients undergone ERCP and accompanied with one or more PEP-associated risk factors from November 2013 to November 2016 at Huaibei People’s Hospital were enrolled, and were divided randomly into pancreatic duct stenting group (observation group) and non-stenting group (control group). Serum levels of amylase at 4, 24 and 48 hours after the procedure and incidence of PEP were compared between the two groups.Results: A total of 297 patients were enrolled, and 147 patients were in observation group, and 150 patients in control group. No significant differences in gender, age and ERCP disease spectrum were found between the two groups (P>0.05). Incidence of PEP was significantly decreased in observation group than in control group (6.1%vs. 16.0%,P<0.05). Serum levels of amylase at 4, 24 and 48 hours after the procedure were significantly decreased in observation group than in corresponding control group (P<0.05), however, no significant difference in incidence of hyperamylasemia was found between the two groups (59.2%vs. 54.7%,P>0.05).Conclusions: Prophylactic pancreatic duct stenting may decrease the incidence of PEP in patients accompanied with PEP-associated risk factors, especially could decrease the severity of PEP. However, the incidence of hyperamylasemia is not decreased.

KeywordsCholangiopancreatography, Endoscopic Retrograde; Stents; Post-ERCP Pancreatitis; Hyperamylasemia; Risk Factors

ERCP最常見的并發癥是ERCP術后胰腺炎(post-ERCP pancreatitis, PEP)，患者相關危險因素和操作者相關危險因素均可增加PEP的發生率。多項研究發現PEP的發生率為3%～15%，伴有危險因素者的發生率甚至可達30%～50%[1-4]。少數患者會進展至重度胰腺炎，故PEP的預防一直是消化內鏡學者關注的熱點。已有多項臨床研究[5-6]發現，胰管支架可作為預防PEP的有效手段。本前……