吲哚美辛对50岁以下患者十二指肠乳头小切开联合球囊扩张取石术后胰腺炎的预防作用

Indomethacin preventing post-ERCP pancreatitis in patients aged under 50 years undergoing sEST combined with EPBD of choledocholithiasis

目的研究吲哚美辛术前直肠给药对50岁以下患者十二指肠乳头小切开联合球囊扩张取石术后胰腺炎的预防作用。方法选取患有胆总管结石50岁以下患者202例,随机分为2组,其中治疗组101例术前予以吲哚美辛直肠给药,对照组101例予以安慰剂术前给药,2组均行十二指肠乳头小切开联合球囊扩张取石术。术后监测患者腹痛NRS评分、淀粉酶、胰腺炎、住院时间等情况。并统计患者出现烧心、皮疹、消化道出血的情况。结果对照组术后24 h疼痛NRS评分(0.634±1.027)分,治疗组术后24 h疼痛NRS评分(0.327±0.763)分;对照组术后24 h淀粉酶为(185.38±160.60)U/L,治疗组术后24 h淀粉酶(116.87±113.97)U/L;对照组术后发生胰腺炎11例(10.89%),治疗组术后发生胰腺炎3例(2.97%);对照组术后住院时间(7.29±2.71)d,治疗组术后住院时间(6.42±2.11)d;2组疼痛NRS评分、淀粉酶、胰腺炎发病率、术后住院时间差异具有统计学意义(P<0.05)。2组术后出现烧心、皮疹、消化道出血情况差异经分析无统计学意义。结论吲哚美辛术前直肠给药能够有效预防50岁以下患者十二指肠乳头小切开联合球囊扩张取石术后的胰腺炎,并且具有较好的安全性。

Objective To study the effect of indomethacin preventing post-ERCP pancreatitis（ PEP） on the patients younger than 50 years undergoing small endoscopic sphincterotomy（ sEST） combined with endoscopic papillary balloon dilation（ EPBD） in the treatment of choledocholithiasis.Methods 202 patients younger than 50 years with choledocholithiasis were divided into two groups,101 patients in treatment group before surgery were rectal administrated with indometacin,101 patients in control group were administered with placebo,all patients underwent sEST combined with EPBD in the treatment of choledocholithiasis. After operation,the abdominal pain NRS score,amylase,incidence of pancreatitis and hospitalization time were recorded,and the rates of heartburn,rash,gastrointestinal bleeding were recorded. Results In the treatment group,pain NRS score 24 hours after operation was（ 0. 327 ± 0. 763）,amylase 24 hours after operation was（ 116. 87 ± 113. 97） U/L,there were 3 cases of postoperative pancreatitis（ 2. 97%） in the treatment group,and the postoperative hospitalization time was（ 6. 42 ± 2. 11） days. In the control group,pain NRS score 24 hours after operation was（ 0. 634 ± 1. 027）,amylase 24 hours after operation was（ 185. 38 ± 160. 60） U/L,there were 11 cases of postoperative pancreatitis（ 10. 89%） in the control group,and the postoperative hospitalization time were（ 7. 29 ± 2. 71） days. The differences of NRS pain score,amylase,incidence of pancreatitis,postoperative hospitalization time between these two groups were statistically significant（ P〈0. 05）. The differences of the rates of postoperative heartburn,rash,gastrointestinal bleeding between these two groups were not statistically significant. Conclusion Indomethacin rectal administration can prevent post-ERCP pancreatitis（ PEP） on the patients who undergoing sEST combined with EPBD in the treatment of choledocholithiasis,and this administration is quite security.