肾上腺素对内镜逆行胰胆管造影高危因素患者术后胰腺炎的预防作用
|
摘要
目的观察肾上腺素对内镜逆行胰胆管造影(ERCP)高危因素患者术后胰腺炎的预防作用。方法选取2018年1月至2018年8月在南京医科大学第二附属医院消化医学中心收治的需行ERCP诊疗的高危因素患者137例为研究对象,随机双盲分为3组:0.01%肾上腺素喷洒十二指肠乳头50例为A组,吲哚美辛栓100 mg肛塞44例为B组,0.01%肾上腺素喷洒十二指肠乳头联合吲哚美辛栓肛塞45例为C组。前瞻性的对比分析各组术后胰腺炎发生情况及严重度,详细记录术中情况及术后高淀粉酶血症及胰腺炎发生率。结果胰腺炎发生率肾上腺素组2例,吲哚美辛组3例,联合组0例,3组比较差异无统计学意义(P>0.05);高淀粉酶血症发生率C组0.05);术后3 h血淀粉酶水平:肾上腺素组>吲哚美辛栓组>肾上腺素与吲哚美辛栓联合组,3组比较差异有统计学意义(P<0.05)。结论肾上腺素喷洒十二指肠乳头可以预防后胰腺炎,高危因素病人行ERCP时可联合吲哚美辛栓肛塞减少术后胰腺炎的发生率。
Objective To observe the preventive effect of epinephrine on pancreatitis after endoscopic retrograde cholangiopancreatography(post-ERCP) in patients with high risk factors.Methods A total of 137 patients with high-risk factors of post-ERCP pancreatitis receiving ERCP were randomly divided into three groups:50 patients treated with 0.01% epinephrine spraying on papilla(group A);44 patients with 100 mg indomethacin suppository for anal insertion(group B);45 patients with 0.01% adrenaline spraying papilla combined with indomethacin suppository for anal insertion(group C).Prospective comparative analysis of the occurrence and severity of post-ERCP pancreatitis was made,and intraoperative condition,postoperative hyperamylasemia and incidence of pancreatitis were recorded in detail among three groups.Results There were no significant differences in cases of pancreatitis(2 vs 3 vs 0,P>0.05) and incidence of hyperamylasemia(44.00% vs 47.73% vs 41.86%,P>0.05) among A-,B-and C-group.The serum amylase level 3-hour after ERCP decreased statistically in the order of A-,B-and C-group(P<0.05).Conclusion Epinephrine spraying on the duodenal papilla can prevent post-ERCP pancreatitis,and its incidence can be reduced by combining indomethacin suppository for anal insertion during ERCP in the patients with high-risk factors.
Objective To observe the preventive effect of epinephrine on pancreatitis after endoscopic retrograde cholangiopancreatography(post-ERCP) in patients with high risk factors.Methods A total of 137 patients with high-risk factors of post-ERCP pancreatitis receiving ERCP were randomly divided into three groups:50 patients treated with 0.01% epinephrine spraying on papilla(group A);44 patients with 100 mg indomethacin suppository for anal insertion(group B);45 patients with 0.01% adrenaline spraying papilla combined with indomethacin suppository for anal insertion(group C).Prospective comparative analysis of the occurrence and severity of post-ERCP pancreatitis was made,and intraoperative condition,postoperative hyperamylasemia and incidence of pancreatitis were recorded in detail among three groups.Results There were no significant differences in cases of pancreatitis(2 vs 3 vs 0,P>0.05) and incidence of hyperamylasemia(44.00% vs 47.73% vs 41.86%,P>0.05) among A-,B-and C-group.The serum amylase level 3-hour after ERCP decreased statistically in the order of A-,B-and C-group(P<0.05).Conclusion Epinephrine spraying on the duodenal papilla can prevent post-ERCP pancreatitis,and its incidence can be reduced by combining indomethacin suppository for anal insertion during ERCP in the patients with high-risk factors.
引文
[1] Tierney J,Bhutiani N,Stamp B,et al.Predictive risk factors associated with cholangitis following ERCP[J].Surg Endosc,2018,32(2):799-804.
[2] Rodrigues-Pinto E,MacEdo G,Baron T.ERCP competence assessment:Miles to go before standardization[J].Endosc Int Open,2017,5(8):E718-E721.
[3] Freeman ML,Nelson DB,Sherman S,et al.Complications of endoscopic biliary sphincterotomy[J].N Engl J Med,1996,335(13):909-919.
[4] Wang P,Li ZS,Liu F,et al.Risk factors for ERCP-related complications:A prospective multicenter study[J].Am J Gastroenterol,2009,104(1):31-40.
[5] Zhou WC,Li YM,Zhang QB,et al.Risk factors for postendoscopic retrograde cholangiopancreatography pancreatitis:A retrospective analysis of 7,168 cases[J].Pancreatology,2011,11(4):399-405.
[6] Dumonceau JM,Andriulli A,Elmunzer BJ,et al.Prophylaxis of post-ERCP pancreatitis:European society of gastrointestinal endoscopy (ESGE) guideline-updated june 2014[J].Endoscopy,2014,46(9):799-815.
[7] Jamry A.Risk factors of pancreatitis after endoscopic sphincterotomy.Review of literature and practical remarks based on approximately 10,000 ERCPs[J].Pol Przegl Chir,2017,89(5):29-33.
[8] Ishikawa-Kakiya Y,Shiba M,Maruyama H,et al.Risk of pancreatitis after pancreatic duct guidewire placement during endoscopic retrograde cholangiopancreatography[J].PLoS One,2018,13(1):e0190379.
[9] Kakutani H,Hino S,Ikeda K,et al.Risk factors of post-ERCP pancreatitis at a tertiary referral center in Japan[J].Surg Laparosc Endosc Percutan Tech,2014,24(3):270-273.
[10] Ding X,Zhang FC,Wang YJ.Risk factors for post-ERCP pancreatitis:A systematic review and meta-analysis[J].Surgeon,2015,13(4):218-229.
[11] Lerch MM,Gorelick FS.Models of acute and chronic pancreatitis[J].Gastroenterology,2013,144(6):1180-1193.
[12] Cotton PB,Lehman G,Vennes J,et al.Endoscopic sphincterotomy complications and their management:An attempt at consensus[J].Gastrointest Endosc,1991,37(3):383-393.
[13] Pancreatic Disease Group,Chinese Society of Gastroenterology & Chinese Medical Association.Consensus on the diagnosis and treatment of acute pancreatitis[J].Chin J Dig Dis,2010,6(1):47-51.
[14] 乔娜,孙备,王刚,等.ERCP术后胰腺炎的研究进展[J].中华胰腺病杂志,2017,17(3):213-216.
[15] Mazaki T,Mado K,Masuda H,et al.Prophylactic pancreatic stent placement and post-ERCP pancreatitis:An updated meta-analysis[J].J Gastroenterol,2014,49(2):343-355.
[16] 钱阳阳,赵朕华,廖专,等.ERCP术后胰腺炎的最新研究进展[J].中华胰腺病杂志,2016,16(3):206.
[17] Sotoudehmanesh R,Khatibian M,Kolahdoozan S,et al.Indomethacin may reduce the incidence and severity of acute pancreatitis after ERCP[J].Am J Gastroenterol,2007,102(5):978-983.
[18] Khoshbaten M,Khorram H,Madad L,et al.Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis[J].J Gastroenterol Hepatol,2008,23(7pt2):e11-e16.
[19] Sajid MS,Khawaja AH,Sayegh M,et al.Systematic review and meta-analysis on the prophylactic role of non-steroidal anti-inflammatory drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis[J].World J Gastrointest Endosc,2015,7(19):1341-1349.
[20] Luo H,Zhao LN,Leung J,et al.Routine pre-procedural rectal indometacin versus selective post-procedural rectal indometacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography:A multicentre,single-blinded,randomised controlled trial[J].The Lancet,2016,387(10035):2293-2301.
[21] Ohno T,Katori M,Nishiyama K,et al.Direct observation of microcirculation of the basal region of rat gastric mucosa[J].J Gastroenterol,1995,30(5):557-564.
[22] Akshintala VS,Hutfless SM,Colantuoni E,et al.Systematic review with network meta-analysis:pharmacological prophylaxis against post-ERCP pancreatitis[J].Aliment Pharmacol Ther,2013,38(11/12):1325-1337.
[23] Matsushita M,Takakuwa H,Shimeno N,et al.Epinephrine sprayed on the papilla for prevention of post-ERCP pancreatitis[J].J Gastroenterol,2009,44(1):71-75.
[24] Xu LH,Qian JB,Gu LG,et al.Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by epinephrine sprayed on the papilla[J].J Gastroenterol Hepatol,2011,26(7):1139-1144.
[25] Shah T,Zfass A,Schubert ML.Chemoprevention of post-ERCP pancreatitis with rectal NSAIDs:does poking both ends justify the means?[J].Dig Dis Sci,2015,60(10):2863-2864.
[2] Rodrigues-Pinto E,MacEdo G,Baron T.ERCP competence assessment:Miles to go before standardization[J].Endosc Int Open,2017,5(8):E718-E721.
[3] Freeman ML,Nelson DB,Sherman S,et al.Complications of endoscopic biliary sphincterotomy[J].N Engl J Med,1996,335(13):909-919.
[4] Wang P,Li ZS,Liu F,et al.Risk factors for ERCP-related complications:A prospective multicenter study[J].Am J Gastroenterol,2009,104(1):31-40.
[5] Zhou WC,Li YM,Zhang QB,et al.Risk factors for postendoscopic retrograde cholangiopancreatography pancreatitis:A retrospective analysis of 7,168 cases[J].Pancreatology,2011,11(4):399-405.
[6] Dumonceau JM,Andriulli A,Elmunzer BJ,et al.Prophylaxis of post-ERCP pancreatitis:European society of gastrointestinal endoscopy (ESGE) guideline-updated june 2014[J].Endoscopy,2014,46(9):799-815.
[7] Jamry A.Risk factors of pancreatitis after endoscopic sphincterotomy.Review of literature and practical remarks based on approximately 10,000 ERCPs[J].Pol Przegl Chir,2017,89(5):29-33.
[8] Ishikawa-Kakiya Y,Shiba M,Maruyama H,et al.Risk of pancreatitis after pancreatic duct guidewire placement during endoscopic retrograde cholangiopancreatography[J].PLoS One,2018,13(1):e0190379.
[9] Kakutani H,Hino S,Ikeda K,et al.Risk factors of post-ERCP pancreatitis at a tertiary referral center in Japan[J].Surg Laparosc Endosc Percutan Tech,2014,24(3):270-273.
[10] Ding X,Zhang FC,Wang YJ.Risk factors for post-ERCP pancreatitis:A systematic review and meta-analysis[J].Surgeon,2015,13(4):218-229.
[11] Lerch MM,Gorelick FS.Models of acute and chronic pancreatitis[J].Gastroenterology,2013,144(6):1180-1193.
[12] Cotton PB,Lehman G,Vennes J,et al.Endoscopic sphincterotomy complications and their management:An attempt at consensus[J].Gastrointest Endosc,1991,37(3):383-393.
[13] Pancreatic Disease Group,Chinese Society of Gastroenterology & Chinese Medical Association.Consensus on the diagnosis and treatment of acute pancreatitis[J].Chin J Dig Dis,2010,6(1):47-51.
[14] 乔娜,孙备,王刚,等.ERCP术后胰腺炎的研究进展[J].中华胰腺病杂志,2017,17(3):213-216.
[15] Mazaki T,Mado K,Masuda H,et al.Prophylactic pancreatic stent placement and post-ERCP pancreatitis:An updated meta-analysis[J].J Gastroenterol,2014,49(2):343-355.
[16] 钱阳阳,赵朕华,廖专,等.ERCP术后胰腺炎的最新研究进展[J].中华胰腺病杂志,2016,16(3):206.
[17] Sotoudehmanesh R,Khatibian M,Kolahdoozan S,et al.Indomethacin may reduce the incidence and severity of acute pancreatitis after ERCP[J].Am J Gastroenterol,2007,102(5):978-983.
[18] Khoshbaten M,Khorram H,Madad L,et al.Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis[J].J Gastroenterol Hepatol,2008,23(7pt2):e11-e16.
[19] Sajid MS,Khawaja AH,Sayegh M,et al.Systematic review and meta-analysis on the prophylactic role of non-steroidal anti-inflammatory drugs to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis[J].World J Gastrointest Endosc,2015,7(19):1341-1349.
[20] Luo H,Zhao LN,Leung J,et al.Routine pre-procedural rectal indometacin versus selective post-procedural rectal indometacin to prevent pancreatitis in patients undergoing endoscopic retrograde cholangiopancreatography:A multicentre,single-blinded,randomised controlled trial[J].The Lancet,2016,387(10035):2293-2301.
[21] Ohno T,Katori M,Nishiyama K,et al.Direct observation of microcirculation of the basal region of rat gastric mucosa[J].J Gastroenterol,1995,30(5):557-564.
[22] Akshintala VS,Hutfless SM,Colantuoni E,et al.Systematic review with network meta-analysis:pharmacological prophylaxis against post-ERCP pancreatitis[J].Aliment Pharmacol Ther,2013,38(11/12):1325-1337.
[23] Matsushita M,Takakuwa H,Shimeno N,et al.Epinephrine sprayed on the papilla for prevention of post-ERCP pancreatitis[J].J Gastroenterol,2009,44(1):71-75.
[24] Xu LH,Qian JB,Gu LG,et al.Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by epinephrine sprayed on the papilla[J].J Gastroenterol Hepatol,2011,26(7):1139-1144.
[25] Shah T,Zfass A,Schubert ML.Chemoprevention of post-ERCP pancreatitis with rectal NSAIDs:does poking both ends justify the means?[J].Dig Dis Sci,2015,60(10):2863-2864.