经内镜鼻胆管引流对接受经内镜逆行胰胆管造影的胆总管结石患者并发术后胰腺炎的预防效果观察

Clinical effect of endoscopic nasobiliary drainage in prevention of post- ERCP pancreatitis in patients with choledocholithiasis

目的探讨经内镜鼻胆管引流(ENBD)预防胆总管结石经内镜逆行胰胆管造影(ERCP)术后胰腺炎(PEP)及高淀粉酶血症的临床作用。方法收集2010年10月-2013年12月行ERCP取石治疗的胆总管结石患者560例,根据术中是否放置鼻胆管分为ENBD组(试验组)371例和非ENBD组(对照组)189例,观察术后3、24 h血清淀粉酶水平及PEP和高淀粉酶血症的发生率。两组间计量资料的比较采用t检验,率的比较采用卡方检验。结果试验组PEP及高淀粉酶血症发生率分别为8.1%(30/371)和13.7%(51/371),显著低于对照组13.8%(26/189)(χ2=4.47,P=0.034)和21.2%(40/189)(χ2=5.06,P=0.024)。试验组患者术后3及24 h血清淀粉酶值分别为(215.34±304.00)U/L、(199.38±273.32)U/L,显著低于对照组(283.28±261.76)U/L、(257.05±199.25)U/L,差异有统计学意义(t=2.61、2.57,P均=0.01)。结论 ENBD可有效预防PEP及高淀粉酶血症的发生。

Objective To investigate the clinical effect of endoscopic nasobiliary drainage （ENBD）in the prevention of post-endoscopic retrograde cholangiopancreatography （ERCP）pancreatitis （PEP）and hyperamylasemia in patients with choledocholithiasis.Methods A total of 560 patients with choledocholithiasis who underwent ERCP from October 2010 to December 2013 were included in the study.ENBD was performed in 371 patients （test group）,and the other 189 patients were designated as control group.Serum amylase level was measured at 3 and 24 h after ERCP,and the incidence of PEP and hyperamylasemia was determined.Comparison of continuous data between the two groups was made by t test,while comparison of rates was made by chi-square test.Results The incidence rates of PEP and hyperamy-lasemia in the test group were 8.1% （30/371）and 13.7% （51/371）,respectively,significantly lower than those in the control group （13.8%,26/189;21.2%,40/189）,（χ2 =4.47,P=0.034;χ2 =5.06,P=0.024）.The serum amylase levels at 3 and 24 h after ERCP in the test group were 215.34 ±304.00 U/L and 199.38 ±273.32 U/L,respectively,significantly lower those in the control group （283.28 ±261.76 U/L and 257.05 ±199.25 U/L）（t=2.61,P=0.01;t=2.57,P=0.01）.Conclusion ENBD can effectively re-duce the incidence of PEP and hyperamylasemia in patients with choledocholithiasis.