ENBD预防治疗性ERCP术后高淀粉酶血症及胰腺炎

Prevention of Pancreatitis and Hyperamylasemia after Therapeutic ERCP by Endoscopic Nosal Biliary Drainage

目的探讨内镜鼻胆管引流术(ENBD)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98例治疗性ERCP术后有高淀粉酶血症及胰腺炎可能的病人。50例高危病人术后置鼻胆管引流,与48例非引流病人术后静脉滴注5%GS500ml+法莫替丁20mg,1次/d进行对照研究。观察术后2h和24h血清淀粉酶值、高淀粉酶血症和急性胰腺炎发生率。结果预防组ERCP术后2h,24h血淀粉酶分别为(271.12±228.86)U/L和(308.31±249.83)U/L;明显低于对照组(736.98±421.36)U/L和(722.10±396.42)U/L,(P<0.01);预防组发生胰腺炎2例,占4%,对照组发生8例,占14.6%(P<0.05);两组基础数据如年龄、操作过程(诊断和治疗)、造影剂的使用量、胰胆管显影次数等基本相似。结论ENBO对治疗性ERCP术后高淀粉酶血症及胰腺炎有预防作用。

Objective To assess the applicative value of endoscopic nasol biliary drainage （ENBD） to the prevention of pancreatitis and hyperamylasemia after therapeutic endoscopic retrograde cholangio-pancreatography （ERCP）. Methods A total of 98 patients in high risk of acute pancreatitis and hyperamylasemia after therapeutic ERCP were divided into two groups. Trial group （ n = 50 ） underwent ENBD after ERCR papillosphincterotomy and basket lithotripsy. Without ENBD, control group （n = 48） was treated by famotidine （20mg, added to 500 ml of 5% glucose solution）. The mean amylase levels were measured two and 24 hr, after therapeutic ERCP. Meanwhile, the occurrence of acute pancreatitis and hyperamylasemia was also observed. Results The mean concentrations of serum amylase at the above time points were respectively （271.12 ±228.86 u/L） and （308.31 ± 249.83） in the trial group, and in the control group the counterparts were （736.98 ±421.36） and （722.10±396.42）. There were significant differences between the two groups （ P 〈 0.01 ）. Eight cases of acute pancreatitis occurred in the control group （ 16.7% ） and two in the trial group （ 4% ） after ERCP （ P 〈 0.05 ）. So the mean concentration of serum amylase and the rate of pancreatitis after ERCP were significantly lower in the trial group than in the control group. The two groups were matched on such aspects as sex, age, developer dosage, etc. Conclusion It is indicated that ENBD can prevent pancreatitis and hyperamylasernia after ERCP.