生长抑素及吲哚美辛栓对预防ERCP术后急性胰腺炎及高淀粉酶血症的回顾性分析

Retrospective analysis of somatostatin and indomethacin in the prevention of acute pancreatitis and hyperamylasemia after ERCP

目的:探讨术前应用生长抑素和吲哚美辛栓对于预防内镜下逆行性胰胆管造影术( endoscopic retrograde cholangiopancreatography,ERCP)术后并发急性胰腺炎和高淀粉酶血症的临床应用价值。方法:回顾性分析2016-08~2018-09在我科接受进行ERCP治疗的158例患者的临床病例资料,根据术前是否应用生长抑素、吲哚美辛栓剂,将其分为生长抑素(A)组56例、吲哚美辛栓剂(B)组32例和双药联合(C)组70例。比较3组患者术后12h及24h血清淀粉酶水平,评估3组患者术后急性胰腺炎及高淀粉酶血症的发病率;探讨生长抑素及吲哚美辛栓预防术后急性胰腺炎及高淀粉酶血症并发症的治疗效果及应用价值。结果:ERCP术后12h血清淀粉酶水平:A组(352.32±127.41)U/ L,B组(425.93±135.62)U/ L,C组(304.27±130.34) U/ L。 ERCP术后24h血清淀粉酶水平:A组(300.18±85.35)U/ L,B组(378.24±131.67)U/ L,C组(260.62±60.31)U/ L。术后胰腺炎的发生率:A组4例(7.14%),B组3例(9.37%),C组3例(4.28%)。B组术后胰腺炎发生率明显高于A组,两组比较差异有显著(P<0.05)。 C组术后胰腺炎发生率明显高于A组及B组,两组比较差异有显著(P<0.05)。术后高淀粉酶血症发生率:A组4例(7.14%),B组3例(9.37%),C组4例(5.71%)。B组术后高淀粉酶血症发生率明显高于A组,两组比较差异有显著(P<0.05)。 C组术后高淀粉酶血症发生率明显高于A组及B组,两组比较差异有显著(P<0.05)。结论:①术前应用生长抑素预防ERCP后急性胰腺炎的发生优于吲哚美辛栓。②吲哚美辛栓联合生长抑素可以达到比使用单一药物更佳的术后急性胰腺炎防治效果。

Objective:To explore and summarize the clinical value of preoperative application of somatostatin and indomethacin suppository in the prevention of acute pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography (ERCP). Methods:Retrospectively analyzed the clinical case data of 158 patients who underwent ERCP in our department from August 2016 to September 2018. According to the preoperative application of somatostatin and indomethacin suppository, they were divided into 56 cases of somatostatin (A) group, 32 cases of indomethacin suppository (B) group and 70 cases of double drug combination (C) group. According to the criteria set by Cotton et al. postoperative acute pancreatitis with PEP and hyperamylasemia were diagnosed, the serum amylase levels at 12 hours and 24 hours after operation in 3 groups were compared, and the postoperative acute pancreatitis and hyperamylasemia in 3 groups were evaluated. Results:The incidence of postoperative pancreatitis in group B was significantly higher than that in group A. There was significant difference between the two groups (P<0.05). The incidence of postoperative pancreatitis in group C was significantly higher than that in group A and group B. There was significant difference between the two groups (P <0.05). The incidence of hyperamylasemia in group B was significantly higher than that in group A. There was significant difference between the two groups (P <0.05). The incidence of hyperamylasemia in group C was significantly higher than that in group A and group B. There was significant difference between the two groups (P<0.05). Conclusion:①Preoperative application of somatostatin to prevent acute pancreatitis after ERCP is better than the application of indomethacin suppository.② Indomethacin combined with somatostatin can achieve better postoperative acute pancreatitis prevention and treatment than the use of a single drug.