内镜鼻胆管引流预防治疗性ERCP术后高淀粉酶血症及胰腺炎
摘要
目的：探讨内镜鼻胆管引流术预防治疗性ERCP术后高淀粉酶血症及胰腺炎的应用价值。方法：140例治疗性ERCP术后有高淀粉酶血症及胰腺炎可能的病人。54例高危病人术后置鼻胆管引流，与86例非引流病人进行对照研究。观察术后2hr＼24hr血清淀粉酶值、高淀粉酶血症和急性胰腺炎发生率。结果：两组病人术后2hr血清淀粉酶值分别为170.68±116.45和275.84±333.11(P＜0.05)，高淀粉酶血症分别为9.26％和26.74％(P＜0.05)，急性胰腺炎发生率分别为0与6.98％(P＜0.05)，均具有显著差异；两组病人术后24hr血清淀粉酶值分别为234.47±437.08和349.49±504.52(P＞0.05)无显著差异；胰管显影率分别为39％和34％(P＞0.05)也无显著差异。结论：内镜鼻胆管引流能保持胆胰引流通畅，防止胆汁反流入胰管，预防治疗性ERCP术后高淀粉酶血症及胰腺炎。
Objective:To assess the value of endoscopic nasol biliary drainage (ENBD)to prevent post therapeutic ERCP pancreatitis and hyperamylasemia. Methods:A series of 140patients in high risk of acute pancreatitis and hyperamylasemia after therapeutic ERCP were divided into two groups. 54patients underwent ENBD after ERCP,papillosphincterotomy and basket lithotripsy. The mean amylase lever at 2hr and 24hr after therapeutic ERCP were measured. Meanwhile the occuring of acute pancreatitis and hyperamylasemia were also observed. Results:The mean amylase lever at 2hr of the drainage group was 1 70.68 + 1 1 6. 45,significantly higher than that in the controls. ( 275.84 +333.1 1,P<0. 05). Hyperamylasemia occurred in 9.26% of patients in drainage group compared with 26.74% of patients in non-drainage group .( PO.05) Acute pancreatitis was clinically established in 6.98% of patients in non-drainage group with significance ( P<0.05)when compared with the drainage group(0%). There were significant differences in the mean amy
lase lever at 2h and the incidence of acute pancreatitis and hyperamylasemia. The mean amylase lever at 24hr of the drainage group was 234.47 + 437. 08,no difference with that in the controls (349.49 +504.52,P>0.05).Conc1usions:ENBD can decrease the pressure within the biliary and pancreatic duct effectively and alleviate the development of pancreatitis. It is considered that ENBD is a practise
of choice for selected to prevent post therapeutic ERCP pancreatitis and hyperamylasemia.
Objective:To assess the value of endoscopic nasol biliary drainage (ENBD)to prevent post therapeutic ERCP pancreatitis and hyperamylasemia. Methods:A series of 140patients in high risk of acute pancreatitis and hyperamylasemia after therapeutic ERCP were divided into two groups. 54patients underwent ENBD after ERCP,papillosphincterotomy and basket lithotripsy. The mean amylase lever at 2hr and 24hr after therapeutic ERCP were measured. Meanwhile the occuring of acute pancreatitis and hyperamylasemia were also observed. Results:The mean amylase lever at 2hr of the drainage group was 1 70.68 + 1 1 6. 45,significantly higher than that in the controls. ( 275.84 +333.1 1,P<0. 05). Hyperamylasemia occurred in 9.26% of patients in drainage group compared with 26.74% of patients in non-drainage group .( PO.05) Acute pancreatitis was clinically established in 6.98% of patients in non-drainage group with significance ( P<0.05)when compared with the drainage group(0%). There were significant differences in the mean amy
lase lever at 2h and the incidence of acute pancreatitis and hyperamylasemia. The mean amylase lever at 24hr of the drainage group was 234.47 + 437. 08,no difference with that in the controls (349.49 +504.52,P>0.05).Conc1usions:ENBD can decrease the pressure within the biliary and pancreatic duct effectively and alleviate the development of pancreatitis. It is considered that ENBD is a practise
of choice for selected to prevent post therapeutic ERCP pancreatitis and hyperamylasemia.
引文
(1) Wojtum S, Gil J, Gietka W. Endoscopic sphincterotomy for choledochelithiasis. A prospective Single-Center on the short-term and long-term treatment results in 483 patients. Endoscopy, 1997;40: 697.
(2) Sherman S. ERCP and endoscopic sphincterotomy-induced pancreatitis. Am J Gastroenterol, 1994; 89: 303-305.
(3) Sherman S, lehman GA. ERCP and endoscopic sphincterctomy-induced pancreatitis. Pancreas, 1991; 6: 350-367.
(4) 沈洁，周怡和，王国良等．诊断性ERCP并发症分析．世界华人消化杂志，1999；7(6)：509。
(5) 周春立，贾黎明．内镜下逆行胰胆管造影术后近期并发症原因及防治。苏州医学院学报，1999；19(7)：827。
(6) 李兆申，许国铭，钱煦岱．胰腺疾病患者ERCP术后并发高淀粉酶血症及急性胰腺炎临床对比研究．中华消化内镜杂志，1999；16(2)：75-77。
(7) Freeman ML, Nelson DB,Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med, 1996;335:909-918.
(8) Joseph E,Geenen. A\S\G\E.distinguished lecture endoscopic theraphy of pancreatic disease: a new-horizon. Gastrointestinal Endoscopy, 1998; 34(5):386.
(9) 鞠金涛，李兆申，许国铭．内镜下乳头括约肌切开术常见并发症研究近况．国外医学消化分册，1998；(2)：95-97。
(10) 田伏洲，黄大熔，黎冬暄等．内镜鼻胆管引流术预防急性胰腺炎重症化的前瞻性研究．中华消化杂志，1997；170(1)：52-53。
(11) 王学汉，杨伦红，胡康等．经内镜治疗急性胰腺炎临床探讨．中华消化内镜杂志，1999；16(2)：83-85。
(2) Sherman S. ERCP and endoscopic sphincterotomy-induced pancreatitis. Am J Gastroenterol, 1994; 89: 303-305.
(3) Sherman S, lehman GA. ERCP and endoscopic sphincterctomy-induced pancreatitis. Pancreas, 1991; 6: 350-367.
(4) 沈洁，周怡和，王国良等．诊断性ERCP并发症分析．世界华人消化杂志，1999；7(6)：509。
(5) 周春立，贾黎明．内镜下逆行胰胆管造影术后近期并发症原因及防治。苏州医学院学报，1999；19(7)：827。
(6) 李兆申，许国铭，钱煦岱．胰腺疾病患者ERCP术后并发高淀粉酶血症及急性胰腺炎临床对比研究．中华消化内镜杂志，1999；16(2)：75-77。
(7) Freeman ML, Nelson DB,Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med, 1996;335:909-918.
(8) Joseph E,Geenen. A\S\G\E.distinguished lecture endoscopic theraphy of pancreatic disease: a new-horizon. Gastrointestinal Endoscopy, 1998; 34(5):386.
(9) 鞠金涛，李兆申，许国铭．内镜下乳头括约肌切开术常见并发症研究近况．国外医学消化分册，1998；(2)：95-97。
(10) 田伏洲，黄大熔，黎冬暄等．内镜鼻胆管引流术预防急性胰腺炎重症化的前瞻性研究．中华消化杂志，1997；170(1)：52-53。
(11) 王学汉，杨伦红，胡康等．经内镜治疗急性胰腺炎临床探讨．中华消化内镜杂志，1999；16(2)：83-85。