ENBD与生长抑素单用或联用预防胆总管多发结石患者ERCP术后胰腺炎的效果分析

A comparative study of ENBD and somatostatin used alone or in combination on prevention of post-ERCP hyperamylasemia and pancreatitis in patients with multiple choledocholithiasis

目的探讨内镜下鼻胆管引流术(ENBD)与生长抑素单用或联用预防胆总管多发结石患者行内镜逆行胰胆管造影术(ERCP)术后急性胰腺炎(PEP)及高淀粉酶血症的效果。方法收集2008年7月至2017年3月萍乡市人民医院250例胆总管结石患者,分成3组:生长抑素组(76例)、ENBD组(84例)、生长抑素+ENBD组(90例)。比较3组患者ERCP术后高淀粉酶血症和PEP的发生率、胆总管结石复发率、胆管感染率、出血发生率,术后视觉模拟评分法(VAS)疼痛评分、术后住院时间、腹痛消失时间、白细胞恢复正常时间、术后费用、术后血淀粉酶和C反应蛋白(CRP)水平。结果与生长抑素组比较,ENBD组与生长抑素+ENBD组高淀粉酶血症、PEP发生率、胆总管结石复发率和胆管感染发生率均明显降低(P<0.05);ENBD组与生长抑素+ENBD组比较,差异无统计学意义(P>0.05)。3组出血发生率比较,差异无统计学意义(P>0.05)。3组术后3hVAS疼痛评分比较,差异无统计学意义(P>0.05);术后24、48hVAS疼痛评分比较,ENBD组与生长抑素+ENBD组较生长抑素组明显降低(P<0.05),ENBD组与生长抑素+ENBD组比较,差异无统计学意义(P>0.05)。比较3组术后住院时间、腹痛消失时间、白细胞恢复正常时间,生长抑素+ENBD组<ENBD组<生长抑素组,差异有统计学意义(P<0.05);术后费用比较,生长抑素+ENBD组与ENBD组较生长抑素组明显增多(P<0.05),生长抑素+ENBD组与ENBD组比较,差异无统计学意义(P>0.05)。术后3、24h血淀粉酶和CRP水平比较,生长抑素+ENBD组与ENBD组较生长抑素组明显降低(P<0.05),生长抑素+ENBD组与ENBD组比较,差异无统计学意义(P>0.05)。结论生长抑素和ENBD能降低胆总管多发结石患者ERCP术后PEP及高淀粉酶血症的发生率,ENBD的效果优于生长抑素,二者联用效果进一步提高。

Objective To investigate the effect of endoscopic nasobiliary drainage （ENBD） and somatostatin used alone or in combination on prevention of post endoscopic retrograde cholangiopancreatography （ERCP） pancreatitis （PEP） and hyperamylasemia in patients with multiple choledocholithiasis. Methods A total of 250 patients with choledocholithiasis were collected from July 2008 to March 2017 in Pingxiang People′s Hospital,and were divided into three groups：the somatostatin group （76 cases）,the ENBD group （84 cases） and the somatostatin＋ENBD group （90 cases）.The incidence rates of hyperamylasemia and PEP,recurrence rate of choledocholithiasis,infection rate of biliary tract,incidence rate of hemorrhage,visual analogue scale （VAS） pain score,postoperative hospital stay,time of abdominal pain disappear,time of leucocyte count return to normal value,postoperative costs and levels of serum amylase and C-reactive protein （CRP） after ERCP were compared among the three groups. Results Compared with the somatostatin group,the incidence rates of hyperamylasemia and PEP,recurrence rate of choledocholithiasis and infection rate of biliary tract in the ENBD group or the somatostatin＋ENBD group were significantly decreased （ P 〈0.05）,while no significant difference was found between the ENBD group and the somatostatin＋ENBD group （ P 〉0.05）.There was no significant difference in the incidence rate of hemorrhage among the three groups （ P 〉0.05）.No significant difference was found in the VAS pain score among the three groups in 3 hours after operation （ P 〉 0.05）.The VAS pain scores in the ENBD group and the somatostatin＋ENBD group of 24 hours and 48 hours after operation were significantly lower than that in the somatostatin group （ P 〈0.05）,while no significant difference was found between the ENBD group and the somatostatin＋ENBD group （ P 〉0.05）.Compared the postoperative hospital stay,time of abdominal pain disappear and time of leucocyte count return to normal value：the somatostatin＋ENBD group〈the ENBD group〈the somatostatin group,there were significant differences （ P 〈0.05）.The postoperative costs in the somatostatin＋ENBD group and the ENBD group were significantly less than that in the somatostatin group （ P 〈0.05）,while no significant difference was found between the somatostatin＋ENBD group and the ENBD group （ P 〉0.05）.The levels of serum amylase and CRP of 3 hours and 24 hours after operation in the somatostatin＋ENBD group and the ENBD group were significantly less than those in the somatostatin group （ P 〈0.05）,while no significant difference was found between the somatostatin＋ENBD group and the ENBD group （ P 〉0.05）. Conclusion Somatostatin and ENBD can decrease the occurrence rate of PEP and hyperamylasemia after ERCP in patients with multiple choledocholithiasis,and ENBD is more effective than somatostatin,and combinative therapy of ENBD and somatostatin can further improve the effectiveness.