胰管支架预防困难胆管插管ERCP术后急性胰腺炎的前瞻性研究

A prospective study of pancreatic duct stent in preventing post-ERCP pancreatitis of difficult bile duct cannulation

目的探讨经内镜逆行胰胆管造影术（ERCP）中置入胰管支架对困难胆管插管患者ERCP术后急性胰腺炎（PEP）的预防效果。方法120例行ERCP诊疗发生困难胆管插管的患者采用随机数字表法随机分成2组，一组术中置入胰管支架（观察组），另一组未置入（对照组），对比分析2组ERCP术后高淀粉酶血症、PEP的发生率以及术后患者腹痛评分结果。结果观察组发生ERCP术后高淀粉酶血症15例（27．3％），PEP5例（8．3％），无一例重症PEP，术后患者腹痛评分（3．82±1．48）分；对照组发生ERCP术后高淀粉酶血症18例（30．0％），PEP14例（23．3％），重症PEP2例（3．3％），术后患者腹痛评分（4．78±1．93）分。2组ERCP术后高淀粉酶血症发生率比较，差异无统计学意义（P〉0．05）；观察组PEP、重症PEP发生率以及术后患者腹痛评分均明显低于对照组，差异均有统计学意义（P〈0．05）。结论置入胰管支架可以有效降低胆管插管困难所引起的PEP的风险，并能有效缓解患者术后疼痛，具有较好的临床应用价值。

Objective To investigate the efficacy of pancreatic duct stent in preventing post-ERCP pancreatitis （PEP） of difficult bile duct cannulation. Methods A total of 120 patients who underwent diffi- cult bile duct cannulation during routine ERCP were randomized to receive pancreatic duct stent placement （ S group ） or not （ NS group）, and the incidence of PEP, hyperamylasemia and scores of abdominal pain were analyzed. Results There were 15 cases of hyperamylasemia and 5 cases of PEP occurred in S group, but no severe PEP was observed. The score of abdominal pain was （3.82 ± 1.48） in S group. There were 18 cases of hyperamylasemia and 14 cases of PEP occurred, including 2 severe PEP in NS group. The score of abdominal pain was （7.48 ± 1.93 ） in NS group. There was no significant difference in the incidence of hy- peramylasemia between the two groups （P 〉 0. 05）. The incidence of PEP, severe PEP and the scores of ab- dominal pain were lower in the S group （P 〈 0.05 ）. Conclusion Placement of pancreatic duct stent can re- duce the PEP rate of difficult bile duct cannulation and relieve the abdominal pain.