主动胰管引流在预防高危患者内镜逆行胰胆管造影术后胰腺炎中的研究

Study on active pancreatic duct drainage in prevention of pancreatitis after endoscopic retrograde of high risk patients

目的 探讨主动胰管引流在预防高危患者内镜逆行胰胆管造影（ERCP）术后胰腺炎（PEP）中的应用价值。方法 收集2015年1月~2016年5月,在胆道微创外科住院行ERCP手术的患者资料。根据病史、磁共振胰胆管造影（MRCP）、ERCP术中情况,共有114例PEP高危患者置入了胰管引流管,随机选取同期其他130例未做胰管引流的病例作为对照。胰管引流管长度根据术中造影胰管情况决定,两组术后均放置鼻胆管。结果 胰管引流管组在术后血淀粉酶水平、24h腹痛评分、腹痛完全缓解方面明显优于无胰管引流管组（P〈0.01）,胰管引流组PEP发生率为4.4%（5/114）,无胰管引流组为12.3%（16/130）,两组比较差异有统计学意义（P〈0.05）。结论 PEP高危人群ERCP术后常规放置胰管引流管是简单、有效、经济的预防PEP方法。

Objective To explore the application value of active pancreatic duct drainage in prevention of pancreatitis after endoscopic retrograde of high risk patients. Methods Data of patients with ERCP operation in the minimally invasive surgery of biliary tract from January 2015 to May 2016 were gathered. According to medical history, magnetic resonance cholangiopancreatography （MRCP）, ERCP situation, a total of 114 PEP high-risk patients were for pancreatic duct drainage. 130 patients without pancreatic duct drainage in the same period were randomly selected as control group. The length of the drainage tube of the pancreatic duct was determined according to the contrast of the pancreatic duct during the operation. All the patients in the two groups were placed in the nose bile duct. Results Postoperative blood amylase level, 24 hours abdominal pain score, abdominal pain complete remission of pancreatic duct drainage group were significantly better than those of no pancreatic duct drainage group （P〈 0.01）. The incidence of PEP of pancreatic duct drainage group was 4.4%（5/114）,while the incidence of PEP of no pancreatic duct drainage group was 12.3%（16/130）,and the difference between the two groups was significant （P 〈 0.05）. Conclusion Conventional placement of pancreatic duct drainage tube after ERCP operation of PEP high risk population is a simple, effective and economical way to prevent PEP.