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方剑锋 陈志良 沈志宏 鲁葆春.吲哚美辛和胰管支架联合应用预防ERCP术后胰腺炎和高淀粉酶血症的临床研究[J].中国现代医生,2021,59(30):106-110
吲哚美辛和胰管支架联合应用预防ERCP术后胰腺炎和高淀粉酶血症的临床研究
Clinical study of pancreatic duct stent combined with indomethacin in preventing pancreatitis and hyperamylasemia after ERCP
  
DOI:
中文关键词:  吲哚美辛  胰管支架  PEP  高淀粉酶血症
英文关键词:Indomethacin  Pancreatic duct stent  PEP  Hyperamylasemia
基金项目:浙江省自然科学基金资助项目(LY17H030001);浙江省绍兴市科技计划项目(2017B70034)
作者单位
方剑锋 陈志良 沈志宏 鲁葆春 绍兴市人民医院(浙江大学绍兴医院)肝胆胰外科浙江绍兴 312000 
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中文摘要:
      目的 探讨吲哚美辛和胰管支架在预防经内镜逆行胰胆管造影术(ERCP)术后胰腺炎和高淀粉酶血症中的临床应用价值。方法 纳入2018 年1 月至2020 年6 月绍兴市人民医院肝胆胰外科收治的1063 例ERCP 患者,分成高危、中危、低危3 组,再根据随机双盲原则将高危组分成高危A、高危B、高危C 3 组,中危、低危组分成中危A、B 和低危A、B 各2 组。在术后常规处理外,对高危、中危、低危A 组予吲哚美辛栓肛塞,B 组仅常规处理,高危C 组予胰管支架置入联合吲哚美辛栓肛塞。观察术后3、24 h 的血淀粉酶及是否有胰腺炎症状体征、CT 表现。结果 高危C 组高淀粉酶血症发生率为56.6%,胰腺炎发生率为27.7%,较A 组、B 组明显下降,差异有统计学意义(P<0.001),中危A 组高淀粉酶血症发生率为35.0%,胰腺炎发生率为6.5%,较B 组明显下降,差异有统计学意义(P<0.001),低危A 组高淀粉酶血症发生率为4.1%,胰腺炎发生率为0.6%,较B 组明显下降,差异有统计学意义(P<0.05)。结论 对于ERCP 术后胰腺炎高危患者,术中胰管支架置入联合术后吲哚美辛栓肛塞能显著降低术后胰腺炎和高淀粉酶血症的发生率。对于ERCP 术后胰腺炎中低危患者,术后吲哚美辛栓肛塞能显著降低术后胰腺炎和高淀粉酶血症的发生率。
英文摘要:
      Objective To investigate the clinical application value of pancreatic duct stent combined with indomethacin in preventing pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography(ERCP).Methods A total of 1063 Patients received ERCP in the Department of Hepatobiliary and Pancreatic Surgery of Shaoxing People’s Hospital from January 2018 to June 2020 were divided into three groups as the high-,medium-and low-risk group.The high-risk group were further divided into three groups as the high-risk group A,B and C,according to the randomized double-blind principle.The medium-risk group were further divided into two groups as the medium-risk group A and B.The low-risk group were further divided into two groups as the low-risk group A and B.The high-,medium-and low-risk group A were given indomethacin anal embolization,in addition to conventional postoperative treatment.The high-,medium-and low-risk group B were only given conventional treatment.The high-risk group C were given pancreatic duct stent implantation combined with indomethacin anal embolization.The levels of blood amylase at 3 and 24 h after operation,whether there were symptoms and signs of pancreatitis,and CT manifestations were observed.Results The incidences of hyperamylasemia and pancreatitis in the high-risk group C were 56.6% and 27.7%,respectively,which were significantly lower than those in the high-risk group A and B,the difference was statistically significant (P<0.001).The incidences of hyperamylasemia and inflammation in the medium-risk group A were 35.0% and 6.5%,respectively,which were significantly lower than those in the medium-risk group B,the difference was statistically significant(P<0.001).The incidences of hyperamylasemia and pancreatitis in the low-risk group A were 4.1%and 0.6%,respectively,which were significantly lower than those in the low-risk group B,the difference was statistically significant(P<0.05).Conclusion For patients with high risk of pancreatitis after ERCP,intraoperative pancreatic duct stent placement combined with postoperative indomethacin anal embolization can significantly reduce the incidences of postoperative pancreatitis and hyperamylasemia.For patients with low and medium risk of pancreatitis after ERCP,postoperative indomethacin anal embolization can significantly reduce the incidences of postoperative pancreatitis and hyperamylasemia.
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