舌下含化硝酸甘油预防ERCP术后急性胰腺炎及高淀粉酶血症的临床应用研究
|
摘要
目的经内镜逆行胰胆管造影术(Endoscopic retrogradecholangiopancreatograph,ERCP)在我国已经开展近30年,成功率不断提高,已成为胰胆疾病的重要诊断方法之一。但其带来的一系列并发症同样受到关注,尤其是ERCP术后急性胰腺炎和高淀粉酶血症,是ERCP术后最常见的并发症,急性胰腺炎更是最严重的并发症,甚至危及生命。近年来,药物预防ERCP术后急性胰腺炎和高淀粉酶血症的临床研究已取得一定进展,生长抑素、加贝酯等有一定临床疗效,但许多药物临床效果并不令人满意。本研究旨在探讨舌下含化硝酸甘油对ERCP术后血清淀粉酶和C反应蛋白变化的影响,以及对ERCP术后急性胰腺炎和高淀粉酶血症的预防作用。
临床资料和方法选择2008年1月～12月在山东省交通医院肝胆外科住院治疗、经CT或MRI证实为胆总管结石。排除病人全身情况极差,不能耐受内镜检查者,包括心、脑、肝、肾、肺功能严重衰竭等;食管、幽门或十二指肠球部狭窄,十二指肠镜无法通过者;患有严重凝血机制障碍及出血性疾病;患者有胰腺炎、糖尿病病史;术前已有高淀粉酶血症和胰腺炎样疼痛;急性胆系感染;既往有括约肌切开术史;胆总管十二指肠吻合术后;胰腺功能不全;胰腺肿瘤;头孢类药物过敏者。拟实施ERCP、内镜下乳头括约肌切开术(Endoscopicsphincteroto-papillotomy,EST)及经内镜取石的患者100例,按照随机的原则分为硝酸甘油组(n=50例)与对照组(n=50例),由同一位内镜医生对上述患者进行ERCP、EST、内镜取石及放置鼻胆管等操作。硝酸甘油组患者于ERCP术前5～10分钟舌下含化硝酸甘油0.5mg,对照组不予硝酸甘油,两组患者其他处理因素相同。检测两组患者术前、术后3小时、24小时血清淀粉酶水平,术前、术后24小时C反应蛋白(C-reactive protein,CRP)以及术后急性胰腺炎和高淀粉酶血症的发生情况。
结果术前血清淀粉酶:硝酸甘油组(59.04±26.23)U/L,对照组(54.92±20.83)U/L,两组患者术前血清淀粉酶水平的差异无统计学意义(P＞0.05)。术后3小时血清淀粉酶:硝酸甘油组(108.88±152.07)U/L,对照组(196.30±244.41)U/L,硝酸甘油组低于对照组,两组差异有统计学意义(P＜0.05)。术后24小时血清淀粉酶:硝酸甘油组(97.02±113.38)U/L,对照组(234.22±406.05)U/L,硝酸甘油组低于对照组,两组差异有统计学意义(P＜0.05)。术前CRP:硝酸甘油组(13.134±19.81)mg/L,对照组(10.23±15.54)mg/L,两组患者术前CRP水平的差异无统计学意义(P＞0.05)。术后CRP:硝酸甘油组术后24小时CRP(14.46±20.48)mg/L低于对照组(28.36±39.49)mg/L,差异有统计学意义(P＜0.05)。硝酸甘油组ERCP术后高淀粉酶血症6例(6/50;12.0%),急性胰腺炎1例(1/50;2.0%)对照组ERCP术后高淀粉酶血症15例(15/50;30.0%),急性胰腺炎7例(7/50;14.0%);硝酸甘油组高淀粉酶血症及急性胰腺炎的发生率均低于对照组,差异有统计学意义(P＜0.05)。
结论舌下含化硝酸甘油可降低ERCP术后血清淀粉酶及CRP水平,减少ERCP术后急性胰腺炎和高淀粉酶血症的发病率,提高ERCP技术的安全性。
Objective To investigate the effect of nitroglycerin on the impact of serum amylase and C-reactive protein(CRP) after Endoscopic retrograde cholangiopancreatograph (ERCP) and on preventing the acute pancreatitis and hyperamylasemia after ERCP.
Methods One hundred patients diagnosed as common bile duct stones by CT and MRI and planned to undergo ERCP, EST and stones removal under endoscope were selected from January to December in 2008 in Shandong Jiaotong Hospital. These patients were randomly divided into two groups: nitroglycerin group (n=50), in which 0.5mg nitroglycerin was given sublingually in 5-10 minutes before ERCP; Control group (n=50), in which no nitroglycerin was given. The levels of serum amylase of all the patients before ERCP and 3 hours, 24 hours after ERCP and the levels of CRP before and after ERCP were detected. the incidence of hyperamylasemia or the acute pancreatitis after ERCP was also observed too.
Results There was no significantly difference in the level of serum amylase and CRP between the two groups before ERCP(P>0.05). The level of serum amylase in nitroglycerin group was lower than that in control group at 3 hours or 24 hours after ERCP (P<0.05). The levels of CRP in nitroglycerin group were lower than that in control group at 24 hours after ERCP(P<0.05).The incidence of hyperamylasemia (6/50; 12.0%) and the acute pancreatitis after ERCP (1/50; 2.0%) in nitroglycerin group was significantly lower than that in control group (hyperamylasemia: 15/50; 30.0%) (the acute pancreatitis: 7/50; 14.0%) (P<0.05).
Conclusion Sublingual nitroglycerin can decrease the level of serum amylase and CRP, and reduce the attack rate of acute pancreatitis and hyperamylasemia after ERCP. We can prevent acute pancreatitis and hyperamylasemia after ERCP by sublingual nitroglycerin.
临床资料和方法选择2008年1月～12月在山东省交通医院肝胆外科住院治疗、经CT或MRI证实为胆总管结石。排除病人全身情况极差,不能耐受内镜检查者,包括心、脑、肝、肾、肺功能严重衰竭等;食管、幽门或十二指肠球部狭窄,十二指肠镜无法通过者;患有严重凝血机制障碍及出血性疾病;患者有胰腺炎、糖尿病病史;术前已有高淀粉酶血症和胰腺炎样疼痛;急性胆系感染;既往有括约肌切开术史;胆总管十二指肠吻合术后;胰腺功能不全;胰腺肿瘤;头孢类药物过敏者。拟实施ERCP、内镜下乳头括约肌切开术(Endoscopicsphincteroto-papillotomy,EST)及经内镜取石的患者100例,按照随机的原则分为硝酸甘油组(n=50例)与对照组(n=50例),由同一位内镜医生对上述患者进行ERCP、EST、内镜取石及放置鼻胆管等操作。硝酸甘油组患者于ERCP术前5～10分钟舌下含化硝酸甘油0.5mg,对照组不予硝酸甘油,两组患者其他处理因素相同。检测两组患者术前、术后3小时、24小时血清淀粉酶水平,术前、术后24小时C反应蛋白(C-reactive protein,CRP)以及术后急性胰腺炎和高淀粉酶血症的发生情况。
结果术前血清淀粉酶:硝酸甘油组(59.04±26.23)U/L,对照组(54.92±20.83)U/L,两组患者术前血清淀粉酶水平的差异无统计学意义(P＞0.05)。术后3小时血清淀粉酶:硝酸甘油组(108.88±152.07)U/L,对照组(196.30±244.41)U/L,硝酸甘油组低于对照组,两组差异有统计学意义(P＜0.05)。术后24小时血清淀粉酶:硝酸甘油组(97.02±113.38)U/L,对照组(234.22±406.05)U/L,硝酸甘油组低于对照组,两组差异有统计学意义(P＜0.05)。术前CRP:硝酸甘油组(13.134±19.81)mg/L,对照组(10.23±15.54)mg/L,两组患者术前CRP水平的差异无统计学意义(P＞0.05)。术后CRP:硝酸甘油组术后24小时CRP(14.46±20.48)mg/L低于对照组(28.36±39.49)mg/L,差异有统计学意义(P＜0.05)。硝酸甘油组ERCP术后高淀粉酶血症6例(6/50;12.0%),急性胰腺炎1例(1/50;2.0%)对照组ERCP术后高淀粉酶血症15例(15/50;30.0%),急性胰腺炎7例(7/50;14.0%);硝酸甘油组高淀粉酶血症及急性胰腺炎的发生率均低于对照组,差异有统计学意义(P＜0.05)。
结论舌下含化硝酸甘油可降低ERCP术后血清淀粉酶及CRP水平,减少ERCP术后急性胰腺炎和高淀粉酶血症的发病率,提高ERCP技术的安全性。
Objective To investigate the effect of nitroglycerin on the impact of serum amylase and C-reactive protein(CRP) after Endoscopic retrograde cholangiopancreatograph (ERCP) and on preventing the acute pancreatitis and hyperamylasemia after ERCP.
Methods One hundred patients diagnosed as common bile duct stones by CT and MRI and planned to undergo ERCP, EST and stones removal under endoscope were selected from January to December in 2008 in Shandong Jiaotong Hospital. These patients were randomly divided into two groups: nitroglycerin group (n=50), in which 0.5mg nitroglycerin was given sublingually in 5-10 minutes before ERCP; Control group (n=50), in which no nitroglycerin was given. The levels of serum amylase of all the patients before ERCP and 3 hours, 24 hours after ERCP and the levels of CRP before and after ERCP were detected. the incidence of hyperamylasemia or the acute pancreatitis after ERCP was also observed too.
Results There was no significantly difference in the level of serum amylase and CRP between the two groups before ERCP(P>0.05). The level of serum amylase in nitroglycerin group was lower than that in control group at 3 hours or 24 hours after ERCP (P<0.05). The levels of CRP in nitroglycerin group were lower than that in control group at 24 hours after ERCP(P<0.05).The incidence of hyperamylasemia (6/50; 12.0%) and the acute pancreatitis after ERCP (1/50; 2.0%) in nitroglycerin group was significantly lower than that in control group (hyperamylasemia: 15/50; 30.0%) (the acute pancreatitis: 7/50; 14.0%) (P<0.05).
Conclusion Sublingual nitroglycerin can decrease the level of serum amylase and CRP, and reduce the attack rate of acute pancreatitis and hyperamylasemia after ERCP. We can prevent acute pancreatitis and hyperamylasemia after ERCP by sublingual nitroglycerin.
引文
1.麻树人,邵晓冬,张宁,等.治疗性ERCP在胆胰疾病中的应用价值[J].中华消化内镜杂志,2006;23(1):31-33。
2.徐美东,高卫东,周平红,等.胆管恶性梗阻内镜治疗的临床价值[J].中国消化内镜,2007,1(7):36-38。
3.Smits ME,Badiga SM,RauwsEA,et al Long-term results of pancreatic stents in chronic pancreatitis[J].Gastrointest Endosc,1995,42:461-467.
4.Cremer M,Deviere J,Delhaye M,et al Stenting in severe chronic pancreatitis:results of medium-term follow-up in seventy-six patients[J].Endoscopy,1991,23:171-176.
5.Mata A,Bordas JM,Llach J,et al.ERCP in orthotopic liver transplanted patients[J].Hepatogastroenterology,2004,51(60):1801-1804.
6.李兆申.中国ERCP研究现状[J].世界华人消化杂,2000,8(4):446-448.
7.李雅洁,杜勤,黄智铭,等.经内镜逆行胰胆管造影并发症的防治[J].实用医学杂志,2008,24:777-779
8.M Christensen,P Matzen,S Schulze,etal..Complications of ERCP:a prospective study[J].GASTROINTESTINAL ENDOSCOPY.2004,60(5):721-731
9.张东海,李兆申.ERCP相关并发症的危险因素及药物预防进展[J]中华消化内镜杂志2002,19(6):378-380
10.Rabenstein T,Schneider HT.25 years of endoscopic sphincterotomy in Erlangen:Assessment of the experience in 3498 patients[J].Endoscopy,1998,30:A194.
11.朱海航,徐永居,张利.ERCP术后急性胰腺炎药物预防临床研究现状[J].国际消化病杂志,2007;27(6):402-404
12.吴传良.ERCP常见并发症及防治策略[J].医学研究杂志,2009;38(3):92-93
13.Cohen S,Bacon BR,Berlin JA,et al.National Institutes of Health state-of-the-science conference statement:ERCP for diagnosis and therapy[J].Gastrointest Endosc,2002,56:803.
14.杨爱明.ERCP术后胰腺炎的发生与预防[J].中国消化内镜,2007;1(1):58-61.
15.应卫星,朱畴文.内镜逆行胰胆管造影术(ERCP)术后胰腺炎发病的机制研究进展及预防策略[J].中国临床医学2006;13(3):423-425.
16.Cheng CL,Sherman S,Watkins JL,et al.Risk factors for post-ERCP pancreatitis:a prospective multicenter study[J].Am J Gastroenterol,2006;101(1):139-147.
17.张筱凤,张啸.ERCP后高淀粉酶血症和胰腺炎的相关危险因素[J]中华消化内镜杂志2004,21(4):287-288
18.Ammori BJ,Cairns A,Dixon MF,et al.Altered intestinal morpholygy and immunity in patients with acute necrtising pancreatitis[J].J Hepatobiliary Pancreat Surg 2002;9:490-496.
19.Freeman ML,DiSario JA,Nelson DB,et al.Risk factors for post-ERCP pancreatitis:a prospective,multicenter study.Gastrointest Endosc,2001,54:425-434.
20.Aronson N,Flamm CR,Bohn RL,et al.Evidence-based assessment:patient,procedure,or operator factors associated with ERCP complications.Gastrointest Endose,2002,56(6Suppl):S294-302.
21.陈圣开,王济明,郑明友.ERCP后胰腺炎危险因素分析与预防[J].内分泌外科杂志,2008;2(5):312-315.
22.Christoforidis E,Goulimaris I,Kanellos I.et al.Post-ERCP panereatitis and hyperamylasemia:Patients-related and operative risk faetors.Endoseopy,2002,34:286-292.
23.Johnson GK,Geenen JE,Bedford RA,et al A comparison ofnonionic versus ionic contrast media:results of a prospective multicenter study[J].Gastrointest Endosc,1995,42(4):312-316.
24. Cheon YK,Cho KB,Watkins JL, et al Frequency and severity of post-ERCP pacreatitis correlated with extent of pancreatic ductal opacification [J]. Gastrointest Endosc 2007, 65(3): 385-393.
25. Vandervoort J, Soetikno RM,Tham TC, et al Risk factor for complications after performance of ERCP[J].Gastrointest Endosc, 2002, 56(5): 652-656
26.Cavallini G, Frulloni L. Antiproteasic agent in the prevention of post-ERCP pancreatitis:rational for use and clinical results [J].JOP, 2003, 4: 75-82.
27. Francesco VD, Mariani A, Angelini G, et al. Effects of gabexate mesilate, a protease inhibitor, on human sphincter of Oddi motility [J]. Dig Dis Sci, 2002, 47: 741-745.
28.Cavallini G,Tittobello A,Frulloni L,et al.Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography[J]. N Engl J Med,1996,335:919.
29.Andriulli A, Clemente R, Solmi L, et al.Gabexate or somatostatin adminitration before ERCP in patients at high risk for post-ERCP pancreatitis: a multicenter, placebo-controlled, randomized clinical trial [J]. Gas-trointest Endosc, 2002, 56: 488-495.
30.Masci E, Cavallini G, Mariani A, et al.Comparison of two dosing regiments of gabexate in the prophylaxis of post-ERCP pancreatitis [J]. Am J Gastroenterol , 2003, 98:2182-2186.
31. Poon RT,Yeung C,Lo CM,et al.Prophylactic effect of Somatostatin on post-ERCP pancreatitis: A randomized controlled trial[J]. Gastrointest Endosc,1999,49:593.
32.Arvanitidis D,Anagnostopoulos GK,Giannopoulos D,et al.Can somatostatin prevent post-ERCP pancreatitis?Results of a randomized controlled trial[J]. Jgastroenterol Hepatol,2004,19:278.
33. Andriulli A,Clemente R,Solmi L,et al.Gabexate or somatostatin administration before ERCP in patients at high risk for post-ERCP pancreatitis: A multicenter,placebo-controlled,randomized clinical trial[J].Gastrointest Endosc,2002,56:488.
34.许晓倩,李兆申.ERCP术后胰腺炎的药物预防研究进展[J].国外医学.消化系疾病分册,2004;24(6):374-377.
35.陈新谦,金有豫主编.新编药物学.14版.北京:人民卫生出版社,1998,264
36.Beauchant M,Ingrand P,Favriel JM,et al.Intravenous nitroglycerin for prevention of pancreatitis after therapeutic endoscopic retrograde cholangiography:a randomized,double-blind,placebo-controlled multicenter trial.[J]Endoscopy.2008 Aug;40(8):631-636.
37.Sudhindran S,Bromwich E,Edwards PR.Prospective randomized double-blind placeboc-controlled trial of glyceryl trintrate in endoscopic retrogtade cholangiopancreatography-induced pancreatitis[J].British Journal of Surgery,2001,88:1178-1182
38.Moreto M,Zaballa M,Casado I,et al.Transdermal glyceryl trinitrate for prevention of post-ERCP pancreatitis:A randomized double-blind trial.Gastrointest Endosc,2003,57:1-7.
39.许晓倩,张文俊,李兆申.ERCP术后胰腺炎[J].胰腺病学,2003;3(4):243-247.
40.郑爱萍.CRP在急性胰胰炎患者中的临床意义[J].江西医学检验,2007,25(3):225-226
41.许桂英.C反应蛋白水平测定对诊断急性重症胰腺炎的临床意义[J].中国现代药物应用,2009,3(5):108-109
42.刘成玉.临床检验基础[M].北京:中国医药科技出版社,2004:64
43.李兆申,张文俊,潘雪,等.奥曲肽预防ERCP术后胰腺炎及高淀粉酶血症的多中心随机对照临床研究[J].中华消化内镜杂志,2004;21(5):301-305.
44.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.
45.李兆申.内镜逆行胰胆管造影.见:许国铭,李兆申主编.上消化道内镜学.上海:上海科学技术出版社 2003,123-137
46.李兆申.乳头括约肌切开术与成形术.见:许国铭,李兆申主编.上消化道内镜学.上海:上海科学技术出版社 2003,571-585
47.Ito K,Fujita N,Noda Y,et al.Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure[J].World J Gastroenterol,2007;13(28):3855-3860.
48.潘涛,王一平.ERCP术后胰腺炎的研究进展[J].华西医学,2004;19(3):501-503.
49.陈洪,郑爱民,赵志鹏,等.静脉滴注纳洛酮和硝酸甘油在急性胰腺炎中的应用[J].中国航天医药杂志.2003,5(2):51-52
50.Velosy B,Madacsy L,Szepes A,eta|.The effects of somatostatin and octreotide on the human sphincter of Oddi[J].Eur J Gastroenterol Hepatol,1999,11(8):897-901.
51.张春礼,张树友,秦春宏等.硝酸甘油在急性水肿性胰腺炎治疗中的作用及可能机制的探讨[J].中国医药导报,2007;4(2):34-35.
52.陈震,秦鸣放.内镜逆行胰胆管造影术后胰腺炎的预防[J].中国中西医结合外科杂志,2008;14(3):302-303.
1.Rabenstein T,Schneider HT.25 years of endoscopic sphincterotomy in Erlangen:Assessment of the experience in 3498 patients[J].Endoscopy,1998,30:A194.
2.朱海航,徐永居,张利.ERCP术后急性胰腺炎药物预防临床研究现状[J].国际消化病杂志,2007;27(6):402-404
3.吴传良.ERCP常见并发症及防治策略[J].医学研究杂志,2009;38(3):92-93
4.李兆滔,崔西玉,黄燕霞,等.老年病人ERCP术后ERCP术后急性胰腺炎的高危因素探讨及对策.中国内镜杂志,2006,12(3):273-275.
5.杨爱明.ERCP术后胰腺炎的发生与预防[J].中国消化内镜,2007;1(1):58-61.
6.应卫星,朱畴文.内镜逆行胰胆管造影术(ERCP)术后胰腺炎发病的机制研究进展及预防策略[J].中国临床医学 2006;13(3):423-425.
7.Cheng CL,Sherman S,Watkins JL,et al.Risk factors for post-ERCP pancreatitis:a prospective multicenter study[J].Am J Gastroenterol,2006;101(1):139-147.
8.Cheon YK,ChoKB,Watkins JL,et a.l Frequency and severity of post-ERCP pacreatitis correlated with extent of pancreatic ductal opacification[J].Gastrointest Endosc 2007,65(3):385-393.
9.Vandervoort J,SoetiknoRM,Tham TC,et a.l Risk factors for complications after performance of ERCP[J].GastrointestEndosc,2002,56(5):652-656.
10.Freeman ML,Nelson DB,Sherman S,et al.Complications of endoscopic biliar sphincterotomy[J].N Engl J Med,1996,35:909-918.
11.FreemanML,Disario JA,Nelson DB,et a.l Risk factors for post-ERCP pancreatitis:a prospective,multicenter study[J].GastrointestEndosc,2001,54(4):425-434.
12.陈圣开,王济明,郑明友.ERCP后胰腺炎危险因素分析与预防[J].内分泌外科杂志,2008;2(5):312-315
13.Werner J, Z'graggen K, Femandez-del Castillo C, et al. Specfic therapy for local and systemic complications of acute pancreatitis with monoclonal antibodies against ICAM-1 [J]. Ann Surg, 1999,229: 834-840.
14.Boulanger C, Luscher TF. Release of endothelin from the porcine aorta [J]. J Cl Invest, 1990, 85: 587-590.
15. Rey JR, Axon A, Budzynska A, et al. Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.GE.) antibiotic prophylaxis for gastrointestinal endoscopy. European Society of Gastrointestinal Endoscopy. Endoscopy, 1998, 30:318-324.
16. Tulassay Z. Somatostatin and the gastroin-testinal tract [J]. Scand J astroenterol, 1998, Suppl 228: 115-121.
17. Binmoeller KF, Dumas R, Harris AG, et al. Effect of somatostatin analog octreotide on human sphincter of Oddi [J]. Dig Dis Sci, 1992, 37: 773-777.
18. Poon RT, Yeung C, Lo CM, et al. prophylactic effect of somatostatin on post-ERCP pancreatitis: a randomized controlled trial [J]. Gastrointest Endosc, 1999, 49: 593
19. Bordas JM, Toledo V, Llach J, et al. Effects of bolus somatostatin in preventing pancreatitis after endoscopic pancreatography:results of a randomized study [J]. Gastrointest Endosc, 1998,47: 230-234.
20. Andriulli a, Leandro G, Niro G, et al.Pharmacological treatment can prevent pancreatic injury after ERCP: a meta-analysis[J]. Gastrointest Endosc, 2000, 51: 1-7.
21. Andriulli A, Clemente R, Solmi L, et al.Gabexate or somatostatin adminitration before ERCP in patients at high risk for post-ERCP pancreatitis: a multicenter, placebo-con-trolled, randomized clinical trial [J]. Gas-trointest Endosc, 2002, 56: 488-495.
22.Arcidiacono R,Gambitta P,Rossi A,et al.The use of a long-acting somatostatin analogue(octreotide)for prophylaxis of acute pancreatitis after endoscopic sphincterotomy[J] .Endoscopy, 1994,26:715.
23.Testoni PA,Lella F,Bagnolo F,et al.Long term prophylactic administration of octreotide reduces the rise in serum amylase after endoscopic procedures on Vater's papilla[J].Pancreas,1996,13:61.
24.Sternlieb JM,Aronchick CA,Retig JN,et al.A multicenter,randomized,controlled trial to evaluate the effect of prophylactic octreotide on ERCP-induced pancreatitis[J].Am J Gastroenterol,1992,87:1561
25.Binmoeller KF,Harris AG,Dumas R,et al.Does the somatostatin analogue octreotide protect against ERCP induced pancreatitis?[J].Gut,1992,33:1129.
26.Inmoeller KF,Dumas R,Harris AG,et al.Effect of somatostatin analog octreotide on human sphincter of Oddi[J].Dig Dis Sci,1992,37:773.
27.肖建国.李闻.孙刚等,奥曲肽对ERCP术后胰腺炎及高淀粉酶血症的预防作用[J].中国医刊,2008;43(5):32-33
28.Kei I,Naotaka F,Yutaka N,et al Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure[J].World J Gastroenterol,2007,13(28):3855-3860.
29.李兆申.张文俊.潘雪等,奥曲肽预防ERCP术后胰腺炎和高淀粉酶血症的多中心随机对照临床研究[J].中华消化内镜杂志,2004;21(5):301-305
30.Cavallini G,Frulloni L.Antiproteasic agent in the prevention of post-ERCP pancreatitis:rational for use and clinical results[J].JOP,2003,4:75-82.
31.Francesco VD,Mariani A,Angelini G,et al.Effects of gabexate mesilate,a protease inhibitor,on human sphincter of Oddi motility[J].Dig Dis Sci,2002,47:741-745.
32.Cavallini G,Tittobello A,Frulloni L,et al.Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography[J].N EnglJ Med,1996,335:919
33.Masci E,Cavallini G,Mariani A,et al.Comparison of two dosing regiments of gabexate in the prophylaxis of post-ERCP pancreatitis[J].Am J Gastroenterol,2003,98:2182-2186
34.Okuhama Y,Shiraishi M,Higa T,et al.Protective effects of ulinastatin against is chemia reperfusion injury[J].JSurgRes,1999,82(1):34-42.
35.王春友,赵刚.乌司他丁对重症急性胰腺炎的疗效及其作用机制的研究[J].临床外科杂志,2000,8(3):172.
36.宋爱琳.尹兰宁.寇治民,乌司他丁对内镜逆行胰胆管造影术后高淀粉酶血症及急性胰腺炎的预防作用[J].兰州大学学报医学版,2005;31(3):24-26
37.陈新谦,金有豫主编.新编药物学.14版.北京:人民卫生出版社,1998,264
38.Sudhindran S,Bromwich E,Edwards PR.Prospective randomized double-blind placeboc-controlled trial of glyceryl trintrate in endoscopic retrogtade cholangiopancreatography-induced pancreatitis[J].British Journal of Surgery,2001-88:1178-1182
39.Moreto M,Zaballa M,Casado I,et al.Transdermal glyceryl trinitrate for preveetion of post-ERCP pancreatitis:a randomized double-blind trial[J].Gastrointest Endosc,2003,57:1-7.
40.Beauchant M,Ingrand P,Favriel JM,et al.Intravenous nitroglycerin for prevention of pancreatitis after therapeutic endoscopic retrograde cholangiography:a randomized,double-blind,placebo-controlled multicenter trial.[J]Endoscopy.2008 Aug;40(8):631-636.
41.Van Laethem JL,Eskinasi R,Louis H,et al.Gut,1998;43:408-413
42.Deviere J,Van Laethem JL,Eisendrath P,et al.Gastroenterology,2001;120:498-505
43.Raty S,Sand J,Pulkkinen M,et al.Post-ERCP pancreatitis:reduction by routine antibiotics.J Gastrointest Surg,2001,5:339-345.
44.Simon LS.Actions and toxicity of nons- teroidal anti-inflammatory drags[J].Curr Opin Rheumatol,1996,8:169-175.
45.Murray B,Carter R,Imne C,etal.Dielofenae Reduces the incidence of acute panereatitis after endoscopic retrograde cholangiopan- Creatography.Gastroterology,2003,124:1786-1791.
2.徐美东,高卫东,周平红,等.胆管恶性梗阻内镜治疗的临床价值[J].中国消化内镜,2007,1(7):36-38。
3.Smits ME,Badiga SM,RauwsEA,et al Long-term results of pancreatic stents in chronic pancreatitis[J].Gastrointest Endosc,1995,42:461-467.
4.Cremer M,Deviere J,Delhaye M,et al Stenting in severe chronic pancreatitis:results of medium-term follow-up in seventy-six patients[J].Endoscopy,1991,23:171-176.
5.Mata A,Bordas JM,Llach J,et al.ERCP in orthotopic liver transplanted patients[J].Hepatogastroenterology,2004,51(60):1801-1804.
6.李兆申.中国ERCP研究现状[J].世界华人消化杂,2000,8(4):446-448.
7.李雅洁,杜勤,黄智铭,等.经内镜逆行胰胆管造影并发症的防治[J].实用医学杂志,2008,24:777-779
8.M Christensen,P Matzen,S Schulze,etal..Complications of ERCP:a prospective study[J].GASTROINTESTINAL ENDOSCOPY.2004,60(5):721-731
9.张东海,李兆申.ERCP相关并发症的危险因素及药物预防进展[J]中华消化内镜杂志2002,19(6):378-380
10.Rabenstein T,Schneider HT.25 years of endoscopic sphincterotomy in Erlangen:Assessment of the experience in 3498 patients[J].Endoscopy,1998,30:A194.
11.朱海航,徐永居,张利.ERCP术后急性胰腺炎药物预防临床研究现状[J].国际消化病杂志,2007;27(6):402-404
12.吴传良.ERCP常见并发症及防治策略[J].医学研究杂志,2009;38(3):92-93
13.Cohen S,Bacon BR,Berlin JA,et al.National Institutes of Health state-of-the-science conference statement:ERCP for diagnosis and therapy[J].Gastrointest Endosc,2002,56:803.
14.杨爱明.ERCP术后胰腺炎的发生与预防[J].中国消化内镜,2007;1(1):58-61.
15.应卫星,朱畴文.内镜逆行胰胆管造影术(ERCP)术后胰腺炎发病的机制研究进展及预防策略[J].中国临床医学2006;13(3):423-425.
16.Cheng CL,Sherman S,Watkins JL,et al.Risk factors for post-ERCP pancreatitis:a prospective multicenter study[J].Am J Gastroenterol,2006;101(1):139-147.
17.张筱凤,张啸.ERCP后高淀粉酶血症和胰腺炎的相关危险因素[J]中华消化内镜杂志2004,21(4):287-288
18.Ammori BJ,Cairns A,Dixon MF,et al.Altered intestinal morpholygy and immunity in patients with acute necrtising pancreatitis[J].J Hepatobiliary Pancreat Surg 2002;9:490-496.
19.Freeman ML,DiSario JA,Nelson DB,et al.Risk factors for post-ERCP pancreatitis:a prospective,multicenter study.Gastrointest Endosc,2001,54:425-434.
20.Aronson N,Flamm CR,Bohn RL,et al.Evidence-based assessment:patient,procedure,or operator factors associated with ERCP complications.Gastrointest Endose,2002,56(6Suppl):S294-302.
21.陈圣开,王济明,郑明友.ERCP后胰腺炎危险因素分析与预防[J].内分泌外科杂志,2008;2(5):312-315.
22.Christoforidis E,Goulimaris I,Kanellos I.et al.Post-ERCP panereatitis and hyperamylasemia:Patients-related and operative risk faetors.Endoseopy,2002,34:286-292.
23.Johnson GK,Geenen JE,Bedford RA,et al A comparison ofnonionic versus ionic contrast media:results of a prospective multicenter study[J].Gastrointest Endosc,1995,42(4):312-316.
24. Cheon YK,Cho KB,Watkins JL, et al Frequency and severity of post-ERCP pacreatitis correlated with extent of pancreatic ductal opacification [J]. Gastrointest Endosc 2007, 65(3): 385-393.
25. Vandervoort J, Soetikno RM,Tham TC, et al Risk factor for complications after performance of ERCP[J].Gastrointest Endosc, 2002, 56(5): 652-656
26.Cavallini G, Frulloni L. Antiproteasic agent in the prevention of post-ERCP pancreatitis:rational for use and clinical results [J].JOP, 2003, 4: 75-82.
27. Francesco VD, Mariani A, Angelini G, et al. Effects of gabexate mesilate, a protease inhibitor, on human sphincter of Oddi motility [J]. Dig Dis Sci, 2002, 47: 741-745.
28.Cavallini G,Tittobello A,Frulloni L,et al.Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography[J]. N Engl J Med,1996,335:919.
29.Andriulli A, Clemente R, Solmi L, et al.Gabexate or somatostatin adminitration before ERCP in patients at high risk for post-ERCP pancreatitis: a multicenter, placebo-controlled, randomized clinical trial [J]. Gas-trointest Endosc, 2002, 56: 488-495.
30.Masci E, Cavallini G, Mariani A, et al.Comparison of two dosing regiments of gabexate in the prophylaxis of post-ERCP pancreatitis [J]. Am J Gastroenterol , 2003, 98:2182-2186.
31. Poon RT,Yeung C,Lo CM,et al.Prophylactic effect of Somatostatin on post-ERCP pancreatitis: A randomized controlled trial[J]. Gastrointest Endosc,1999,49:593.
32.Arvanitidis D,Anagnostopoulos GK,Giannopoulos D,et al.Can somatostatin prevent post-ERCP pancreatitis?Results of a randomized controlled trial[J]. Jgastroenterol Hepatol,2004,19:278.
33. Andriulli A,Clemente R,Solmi L,et al.Gabexate or somatostatin administration before ERCP in patients at high risk for post-ERCP pancreatitis: A multicenter,placebo-controlled,randomized clinical trial[J].Gastrointest Endosc,2002,56:488.
34.许晓倩,李兆申.ERCP术后胰腺炎的药物预防研究进展[J].国外医学.消化系疾病分册,2004;24(6):374-377.
35.陈新谦,金有豫主编.新编药物学.14版.北京:人民卫生出版社,1998,264
36.Beauchant M,Ingrand P,Favriel JM,et al.Intravenous nitroglycerin for prevention of pancreatitis after therapeutic endoscopic retrograde cholangiography:a randomized,double-blind,placebo-controlled multicenter trial.[J]Endoscopy.2008 Aug;40(8):631-636.
37.Sudhindran S,Bromwich E,Edwards PR.Prospective randomized double-blind placeboc-controlled trial of glyceryl trintrate in endoscopic retrogtade cholangiopancreatography-induced pancreatitis[J].British Journal of Surgery,2001,88:1178-1182
38.Moreto M,Zaballa M,Casado I,et al.Transdermal glyceryl trinitrate for prevention of post-ERCP pancreatitis:A randomized double-blind trial.Gastrointest Endosc,2003,57:1-7.
39.许晓倩,张文俊,李兆申.ERCP术后胰腺炎[J].胰腺病学,2003;3(4):243-247.
40.郑爱萍.CRP在急性胰胰炎患者中的临床意义[J].江西医学检验,2007,25(3):225-226
41.许桂英.C反应蛋白水平测定对诊断急性重症胰腺炎的临床意义[J].中国现代药物应用,2009,3(5):108-109
42.刘成玉.临床检验基础[M].北京:中国医药科技出版社,2004:64
43.李兆申,张文俊,潘雪,等.奥曲肽预防ERCP术后胰腺炎及高淀粉酶血症的多中心随机对照临床研究[J].中华消化内镜杂志,2004;21(5):301-305.
44.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.
45.李兆申.内镜逆行胰胆管造影.见:许国铭,李兆申主编.上消化道内镜学.上海:上海科学技术出版社 2003,123-137
46.李兆申.乳头括约肌切开术与成形术.见:许国铭,李兆申主编.上消化道内镜学.上海:上海科学技术出版社 2003,571-585
47.Ito K,Fujita N,Noda Y,et al.Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure[J].World J Gastroenterol,2007;13(28):3855-3860.
48.潘涛,王一平.ERCP术后胰腺炎的研究进展[J].华西医学,2004;19(3):501-503.
49.陈洪,郑爱民,赵志鹏,等.静脉滴注纳洛酮和硝酸甘油在急性胰腺炎中的应用[J].中国航天医药杂志.2003,5(2):51-52
50.Velosy B,Madacsy L,Szepes A,eta|.The effects of somatostatin and octreotide on the human sphincter of Oddi[J].Eur J Gastroenterol Hepatol,1999,11(8):897-901.
51.张春礼,张树友,秦春宏等.硝酸甘油在急性水肿性胰腺炎治疗中的作用及可能机制的探讨[J].中国医药导报,2007;4(2):34-35.
52.陈震,秦鸣放.内镜逆行胰胆管造影术后胰腺炎的预防[J].中国中西医结合外科杂志,2008;14(3):302-303.
1.Rabenstein T,Schneider HT.25 years of endoscopic sphincterotomy in Erlangen:Assessment of the experience in 3498 patients[J].Endoscopy,1998,30:A194.
2.朱海航,徐永居,张利.ERCP术后急性胰腺炎药物预防临床研究现状[J].国际消化病杂志,2007;27(6):402-404
3.吴传良.ERCP常见并发症及防治策略[J].医学研究杂志,2009;38(3):92-93
4.李兆滔,崔西玉,黄燕霞,等.老年病人ERCP术后ERCP术后急性胰腺炎的高危因素探讨及对策.中国内镜杂志,2006,12(3):273-275.
5.杨爱明.ERCP术后胰腺炎的发生与预防[J].中国消化内镜,2007;1(1):58-61.
6.应卫星,朱畴文.内镜逆行胰胆管造影术(ERCP)术后胰腺炎发病的机制研究进展及预防策略[J].中国临床医学 2006;13(3):423-425.
7.Cheng CL,Sherman S,Watkins JL,et al.Risk factors for post-ERCP pancreatitis:a prospective multicenter study[J].Am J Gastroenterol,2006;101(1):139-147.
8.Cheon YK,ChoKB,Watkins JL,et a.l Frequency and severity of post-ERCP pacreatitis correlated with extent of pancreatic ductal opacification[J].Gastrointest Endosc 2007,65(3):385-393.
9.Vandervoort J,SoetiknoRM,Tham TC,et a.l Risk factors for complications after performance of ERCP[J].GastrointestEndosc,2002,56(5):652-656.
10.Freeman ML,Nelson DB,Sherman S,et al.Complications of endoscopic biliar sphincterotomy[J].N Engl J Med,1996,35:909-918.
11.FreemanML,Disario JA,Nelson DB,et a.l Risk factors for post-ERCP pancreatitis:a prospective,multicenter study[J].GastrointestEndosc,2001,54(4):425-434.
12.陈圣开,王济明,郑明友.ERCP后胰腺炎危险因素分析与预防[J].内分泌外科杂志,2008;2(5):312-315
13.Werner J, Z'graggen K, Femandez-del Castillo C, et al. Specfic therapy for local and systemic complications of acute pancreatitis with monoclonal antibodies against ICAM-1 [J]. Ann Surg, 1999,229: 834-840.
14.Boulanger C, Luscher TF. Release of endothelin from the porcine aorta [J]. J Cl Invest, 1990, 85: 587-590.
15. Rey JR, Axon A, Budzynska A, et al. Guidelines of the European Society of Gastrointestinal Endoscopy (E.S.GE.) antibiotic prophylaxis for gastrointestinal endoscopy. European Society of Gastrointestinal Endoscopy. Endoscopy, 1998, 30:318-324.
16. Tulassay Z. Somatostatin and the gastroin-testinal tract [J]. Scand J astroenterol, 1998, Suppl 228: 115-121.
17. Binmoeller KF, Dumas R, Harris AG, et al. Effect of somatostatin analog octreotide on human sphincter of Oddi [J]. Dig Dis Sci, 1992, 37: 773-777.
18. Poon RT, Yeung C, Lo CM, et al. prophylactic effect of somatostatin on post-ERCP pancreatitis: a randomized controlled trial [J]. Gastrointest Endosc, 1999, 49: 593
19. Bordas JM, Toledo V, Llach J, et al. Effects of bolus somatostatin in preventing pancreatitis after endoscopic pancreatography:results of a randomized study [J]. Gastrointest Endosc, 1998,47: 230-234.
20. Andriulli a, Leandro G, Niro G, et al.Pharmacological treatment can prevent pancreatic injury after ERCP: a meta-analysis[J]. Gastrointest Endosc, 2000, 51: 1-7.
21. Andriulli A, Clemente R, Solmi L, et al.Gabexate or somatostatin adminitration before ERCP in patients at high risk for post-ERCP pancreatitis: a multicenter, placebo-con-trolled, randomized clinical trial [J]. Gas-trointest Endosc, 2002, 56: 488-495.
22.Arcidiacono R,Gambitta P,Rossi A,et al.The use of a long-acting somatostatin analogue(octreotide)for prophylaxis of acute pancreatitis after endoscopic sphincterotomy[J] .Endoscopy, 1994,26:715.
23.Testoni PA,Lella F,Bagnolo F,et al.Long term prophylactic administration of octreotide reduces the rise in serum amylase after endoscopic procedures on Vater's papilla[J].Pancreas,1996,13:61.
24.Sternlieb JM,Aronchick CA,Retig JN,et al.A multicenter,randomized,controlled trial to evaluate the effect of prophylactic octreotide on ERCP-induced pancreatitis[J].Am J Gastroenterol,1992,87:1561
25.Binmoeller KF,Harris AG,Dumas R,et al.Does the somatostatin analogue octreotide protect against ERCP induced pancreatitis?[J].Gut,1992,33:1129.
26.Inmoeller KF,Dumas R,Harris AG,et al.Effect of somatostatin analog octreotide on human sphincter of Oddi[J].Dig Dis Sci,1992,37:773.
27.肖建国.李闻.孙刚等,奥曲肽对ERCP术后胰腺炎及高淀粉酶血症的预防作用[J].中国医刊,2008;43(5):32-33
28.Kei I,Naotaka F,Yutaka N,et al Relationship between post-ERCP pancreatitis and the change of serum amylase level after the procedure[J].World J Gastroenterol,2007,13(28):3855-3860.
29.李兆申.张文俊.潘雪等,奥曲肽预防ERCP术后胰腺炎和高淀粉酶血症的多中心随机对照临床研究[J].中华消化内镜杂志,2004;21(5):301-305
30.Cavallini G,Frulloni L.Antiproteasic agent in the prevention of post-ERCP pancreatitis:rational for use and clinical results[J].JOP,2003,4:75-82.
31.Francesco VD,Mariani A,Angelini G,et al.Effects of gabexate mesilate,a protease inhibitor,on human sphincter of Oddi motility[J].Dig Dis Sci,2002,47:741-745.
32.Cavallini G,Tittobello A,Frulloni L,et al.Gabexate for the prevention of pancreatic damage related to endoscopic retrograde cholangiopancreatography[J].N EnglJ Med,1996,335:919
33.Masci E,Cavallini G,Mariani A,et al.Comparison of two dosing regiments of gabexate in the prophylaxis of post-ERCP pancreatitis[J].Am J Gastroenterol,2003,98:2182-2186
34.Okuhama Y,Shiraishi M,Higa T,et al.Protective effects of ulinastatin against is chemia reperfusion injury[J].JSurgRes,1999,82(1):34-42.
35.王春友,赵刚.乌司他丁对重症急性胰腺炎的疗效及其作用机制的研究[J].临床外科杂志,2000,8(3):172.
36.宋爱琳.尹兰宁.寇治民,乌司他丁对内镜逆行胰胆管造影术后高淀粉酶血症及急性胰腺炎的预防作用[J].兰州大学学报医学版,2005;31(3):24-26
37.陈新谦,金有豫主编.新编药物学.14版.北京:人民卫生出版社,1998,264
38.Sudhindran S,Bromwich E,Edwards PR.Prospective randomized double-blind placeboc-controlled trial of glyceryl trintrate in endoscopic retrogtade cholangiopancreatography-induced pancreatitis[J].British Journal of Surgery,2001-88:1178-1182
39.Moreto M,Zaballa M,Casado I,et al.Transdermal glyceryl trinitrate for preveetion of post-ERCP pancreatitis:a randomized double-blind trial[J].Gastrointest Endosc,2003,57:1-7.
40.Beauchant M,Ingrand P,Favriel JM,et al.Intravenous nitroglycerin for prevention of pancreatitis after therapeutic endoscopic retrograde cholangiography:a randomized,double-blind,placebo-controlled multicenter trial.[J]Endoscopy.2008 Aug;40(8):631-636.
41.Van Laethem JL,Eskinasi R,Louis H,et al.Gut,1998;43:408-413
42.Deviere J,Van Laethem JL,Eisendrath P,et al.Gastroenterology,2001;120:498-505
43.Raty S,Sand J,Pulkkinen M,et al.Post-ERCP pancreatitis:reduction by routine antibiotics.J Gastrointest Surg,2001,5:339-345.
44.Simon LS.Actions and toxicity of nons- teroidal anti-inflammatory drags[J].Curr Opin Rheumatol,1996,8:169-175.
45.Murray B,Carter R,Imne C,etal.Dielofenae Reduces the incidence of acute panereatitis after endoscopic retrograde cholangiopan- Creatography.Gastroterology,2003,124:1786-1791.