吲哚美辛联合生长抑素预防ERCP术后胰腺炎

Preventive effect of indomethacin combined with somatostatin on post-ERCP pancreatitis

目的探讨生长抑素联合吲哚美辛预防性治疗内镜逆行胰胆管造影(ERCP)术后胰腺炎的效果及对血清淀粉酶水平的影响。方法选择2017年5月至2018年5月佛山市第一人民医院胆道外科204例行ERCP术的患者为研究对象,随机分为3组,每组68例。A组基础性治疗+安慰剂塞肛,B组基础治疗+术前半小时100 mg吲哚美辛塞肛,C组基础治疗+术前半小时100 mg吲哚美辛塞肛+术中250μg/h生长抑素泵入11 h。比较各组患者术后胰腺炎发生率,ERCP术后6、12、24及48 h血清淀粉酶变化和临床症状体征评分变化。结果 3组患者年龄、性别、病因、胆总管直径、术中Oddi括约肌切开等基本资料比较无统计学差异(P>0.05)。B组和C组术后胰腺炎发生率显著低于A组(P<0.05)。术后6、12、24及48 h B组和C组血清淀粉酶水平、临床症状与体征评分均明显低于A组(P<0.05)。进一步分析显示,C组术后胰腺炎发生率,术后12、24及48 h血清淀粉酶水平及临床症状与体征评分均低于B组(P<0.05)。结论生长抑素联合吲哚美辛能够有效预防ERCP术后胰腺炎发生,同时有效降低血清淀粉酶水平,改善患者临床症状,疗效优于单独给予吲哚美辛治疗,值得临床推广应用。

Objective To discuss the preventive effect of indomethacin combined with somatostatin on pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP) and its influence on serum amylase level. Methods Two hundred and four patients who will undergo ERCP in First People′s Hospital of Foshan from May 2017 to May 2018 were randomly divided into three groups, 68 cases in each group. Group A were given basic treatment+placebo suppository, group B were given basic treatment+30 minutes 100 mg indometacin suppository preoperative, and group C were given basic treatment+30 minutes indometacin suppository preoperative+11 h 250 μg/h somatostatin infusion intraoperative. The incidence of pancreatitis, serum amylase level and scores of clinical symptoms and signs at 6, 12, 24 and 48 h after ERCP were compared among 3 groups. Results There were no significant differences in age, sex, etiology, diameter of common bile duct and intraoperative Oddi sphincterotomy among the three groups (P>0.05). The incidence of postoperative pancreatitis in group B and C was significantly lower than that in group A (P<0.05). The levels of serum amylase, scores of clinical symptoms and signs in group B and C at 6, 12, 24 and 48 h postoperative were significantly lower than those in group A (P<0.05). Further analysis showed that the incidence of postoperative pancreatitis, serum amylase at 12, 24 and 48 h and clinical symptoms and signs scores at 6, 12, 24 and 48 h in group C were significantly lower than those in group B (P<0.05). Conclusion Indomethacin combined with somatostatin can effectively prevent the incidence of pancreatitis after ERCP, and reduce the level of serum amylase, which may be applied in clinical practice.