经鼻胆管灌洗预防内镜逆行胰胆管取石术后胰腺炎和胆管炎的作用

Nasobiliary irrigation on prevention of post-ERCP pancreatitis and cholangitis

[目的]探讨经鼻胆管灌洗对内镜逆行胰胆管造影术(ERCP)取石后胰腺炎(PEP)和胆管炎的预防作用。[方法]采用前瞻性随机对照设计,连续纳入行ERCP取石并留置鼻胆管的患者240例,分为试验组和对照组,试验组术后用0.9%氯化钠溶液30ml经鼻胆管灌洗q6h×3d,对照组常规鼻胆管引流。比较2组术后6h和24h血清淀粉酶水平,以及高淀粉酶血症、PEP和胆管炎的发生率。[结果]试验组、对照组术后6h血清淀粉酶分别为(314.2±89.5)U/L、(455.9±102.1)U/L,2组比较差异有统计学意义(t=11.43,P<0.01);试验组、对照组术后24h血清淀粉酶分别为(197±61.4)U/L、(248±72.9)U/L,2组比较差异有统计学意义(t=5.864,P<0.01)。试验组、对照组高淀粉酶血症(13.3%∶24.2%,χ2=4.622,P=0.032)、PEP(4.17%∶13.3%,χ2=6.314,P=0.012)和胆管炎发生率(0∶8.33%,χ2=6.678,P=0.01)比较均差异有统计学意义。[结论]术后定时经鼻胆管灌洗具有预防ERCP取石术后高淀粉酶血症、PEP和胆管炎的作用。

[Objective] To investigate whether post-procedural nasobiliary irrigation can prevent post- ERCP pancreatitis（PEP）as well as cholangitis on patients with choledocholithiasis. [Methods]Consecutive patients with nasobiliary tube placement after common duct stone removal by ERCP were randomly divided into two groups prospectively. The observe group receivednasobiliary irrigation with 30 ml of physical sa- line four times a day during the initial 3 postprocedural days,while the control group accepted conventional nasobiliary drainage. The serum amylase level at 6 h and 24 h after ERCP were measured. Rates of hyperamylasemia,PEP and cholangitis between the two groups were compared. [Results]A total of 240 patients were enrolled. Postprocedural serum amylase levels at 6h and 24 h in observe group were significantly lower than those in control group,with a mean level of（[314. 2±89.5]U/L vs[455.9±102.1]U/L,t= 11.43,P〈0.01）and（[197±61.4]U/L vs[248±72.9]U/L,t=5. 864,P〈0.01）,respectively. Nasobiliary irrigation resulted in significantly decreased rates of hyperamylasemia（13.3 %vs 24.2%, χ^2 = 4. 622, P = 0. 032）,PEP（4.17% vs 13.3 %,χ^2 =6. 314,P=0. 012）as well as cholangitis（0 vs 8.33%,χ^2 =6. 678,P= 0.01）in observe group compared with control. [Conclusion]Postprocedual nasobiliary irrigation at fixed in- terval plays a role in prevention of PEP and cholangitis after common duct stone removal by ERCP.