选择性胰管支架和非甾体类抗炎药预防ERCP术后胰腺炎的倾向性评分匹配分析

A propensity score matching analysis of prophylactic pancreatic stent and rectal NSAIDs for preven- tion of post-ERCP pancreatitis

目的对比在ERCP术后胰腺炎高危人群中，选择性胰管支架置入和非甾体类抗炎药肛塞的疗效。方法单中心回顾性分析623例ERCP术后胰腺炎高危患者，其中145例选择性置入胰管支架（A组），478例行非甾体类抗炎药肛塞（B组）。采用倾向性评分匹配分析平衡2组间的偏倚，组成145对，统计总的ERCP术后胰腺炎及中重度ERCP术后胰腺炎的发生率。根据危险因素亚组分析选择性胰管支架置入的最佳适应证。结果经过倾向性评分匹配分析，145对中A组和B组分别有10例（6．9％）和22例（15．2％）发生ERCP术后胰腺炎，差异有统计学意义（P〈0．05）。5例（3．4％）和14例（9．7％）发生中重度ERCP术后胰腺炎，差异有统计学意义（P〈0．05）。ERCP术后胰腺炎的危险因素为插管时间〉10min、乳头括约肌预切开、导丝进入胰管〉1次、有经内镜壶腹切除术史。结论尽管非甾体类抗炎药肛塞经济、简单，对于ERCP术后胰腺炎高危患者预防ERCP术后胰腺炎，选择性胰管支架置入是更优的选择。推荐插管时间〉10min、乳头括约肌预切开、导丝进入胰管〉1次、经内镜壶腹切除术的患者置入胰管支架以预防ERCP术后胰腺炎。

Objective To investigate the efficacy of prophylactic pancreatic stent placement and nonsteroidal antiinflammatory drugs（NSAIDs） for the prevention of post-endoscopic retrograde cholangiopan- creatography（ERCP） pancreatitis（PEP）. Methods A total of 623 patients with high risk factors for PEP were treated with prophylactic pancreatic stent placement （ 145 patients, group A） or rectal NSAIDs （478 pa- tients, group B） for PEP prevention by using the propensity score matching （PSM） analysis. Incidence of PEP, moderate and severe PEP were investigated. According to risk factors of PEP, indications of prophy- lactic pancreatic stent placement were analysed. Results Of 623 patients with high risk factors, 145 pairs were generated after PSM.Pancreatitis occurred in 32 patients,10 （6. 9%） in group A and 22 （15.2%） in group B（P〈0.05）. Moderate-to-severe pancreatitis developed in 5 （3.4%）patients in group A mad 14 （9. 7% ） patients in group B （P〈0. 05）. Risk factors of post-ERCP PEP were cannulation attempts duration longer than 10 minutes, precut sphincterotomy, more than one pancreatic guidewire passages and history of ampullectomy. Conclusion Although the NSAIDs represent an easy, inexpensive treatment, prophylactic pancreatic stent placement is still a better prevention strategy for PEP.Prophylactic pancreatic stents should be recommended to those with risk factors including cannulation attempts duration longer than 10 minutes, precut sphincterotomy, more than one pancreatic guidewire passages and ampullectomy.