吲哚美辛栓预防内镜逆行胆胰管造影术胆总管取石术后胰腺炎的研究

Effect of indomethacin in preventing post-endoscopic retrograde cannulation pancreatitis in patients undergoing common bile duct cholecystolithotomy

目的探讨吲哚美辛栓预防内镜逆行胆胰管造影术（ERCP）胆总管取石术后胰腺炎的效果。方法纳入2014年1—12月于民航总医院住院行ERCP胆总管取石术的胆总管结石患者51例，完全随机分为吲哚美辛组（26例）和对照组（25例）。吲哚美辛组于ERCP术前60rain直肠内给予吲哚美辛栓100mg，对照组不予吲哚美辛栓。比较2组患者术后2、6、24h血清淀粉酶和ERCP术后胰腺炎（PEP）及高淀粉酶血症发生率。结果吲哚美辛组术后6和24h血清淀粉酶水平均低于对照组[（202±41）U／L比（409±77）U／L，（111±18）U／L比（264±56）U／L]，差异均有统计学意义（均P〈0．05），术后2h2组间比较差异无统计学意义[（128±20）U／L比（192±29）U／L，P〉0．05]。对照组25例患者中4例（16．O％）出现PEP，吲哚美辛组无一例出现PEP，组问差异有统计学意义（P〈0．05）；对照组12例（48．O％）、吲哚美辛组7例（26．9％）m现术后高淀粉酶血症，组问差异有统计学意义（P〈0．05）。结论直肠应用吲哚美辛栓可以预防ERCP胆总管取石术后胰腺炎和高淀粉酶血症。

Objective To investigate the effect of indomethaein in preventing post-endoscopic retrograde eannulation （ERCP） panereatitis （PEP） in patients undergoing common bile duct choleeystolithotomy. Methods Totally 51 patients with common bile duet stones who underwent ERCP common bile duct eholecysto- lithotomy from Januaiy 2014 to Decembm 2014 were randomly divided into indomethaein group （26 eases ） and control group （25 eases）. Indomethacin group was rectally administrated with indomethaein （ 100 rag） 60 min before operation and control group was not given indomethaein. The serum amylase was detected 2, 6 and 24 h after operation, the incidences of PEP and postoperative hyperamylasemia were compared between groups. Results The serum amylase level in indomethaein group was significantly lower than that in control group 6 and 24 h after ERCP I（202±41） U/L vs （409 ±77） U/L, （111 ±18） U/L vs （264 ±56） U/L] （P〈0.05）, while it was not significantly different between indomethaein group and control group 2 h after ERCP [ （ 128± 20） U/L vs （192 ±29） U/LI （P 〉0.05）. Totally 16.0% （4/25） in control group and 0.0% （0/26） in indomethaein group had PEP, 48.0% （12/25） in control group and 26.9% （7/26） in indomethacin group had hyperamylasemia, both being significantly different between groups （P 〈 0. 05 ）. Conclusion Rectal administration of indomethaein can prevent PEP and postoperative hyperamylasemia in patients who underwent ERCP common bile duet stone eholeeystolithotomy.