ERCP术后胰腺炎的防治

PREVENTION AND TREATMENT FOR POST ERCP PANCREATITIS

目的 探讨内窥镜逆行胰胆管造影 (ERCP)术后胰腺炎乌司他丁 (Ulinastatin,UTI)的防治作用。方法 对1 998年 1月～ 2 0 0 3年 3月我院住院行 ERCP术 1 6 4例病人作回顾性分析总结。结果 1 6 4例行 ERCP术病人随机分为三组 :对照组 6 2例 ,乌司他丁组 6 8例 ,生长抑素组 34例。1 34例插管成功 ,成功率 82 .0 % ,其中胆管、胰管均显影 6 6例 ,胆管显影 4 6例 ,胰管显影 5 2例 ,在胆管显影的 1 1 2例中 ,70例总胆管有扩张 ,直径≥ 1 0 m m,4 2例总胆直径正常 <1 0 m m。预防用药组 ER-CP术后 2 h血清淀粉酶 (乌司他丁 2 2 6 .5± 2 6 2 .9U/ L,生长抑素 2 6 4 .0± 2 0 4 .5 U/ L)、2 4 h血清淀粉酶 (乌司他丁 2 92 .4±31 9.6 U/ L,生长抑素 2 82 .7± 2 93.8U/ L)明显低于对照组组 (5 2 2 .2± 4 96 .2 U/ L,5 0 6 .1± 5 5 9.8U/ L,P<0 .0 1 ) ;乌司他丁组、生长抑素组 ERCP术后 2 h、2 4 h血清淀粉酶水平亦明显高于术前水平 (P<0 .0 5 )。结论 乌司他丁通过减少胰液的分泌量和降低胰酶的浓度 ,能够有效防治

Objective To investigate the role of Ulinastatin in treatment and prevention to post ERCP.Methods We reviewed 164 patients examined by ERCP in our hospital from January 1998 to March 2003,retrospectively.Results 164 cases were divided into 3 teams,team placebo(62 cases)?team Ulinastation(68 cases)and team somatostatin(34 cases).134 cases were intubated successfully,bile duct were expanded in 70 cases,diameter≥10 mm,bile duct were normal in 52 cases.The level of blood serum amylase(Ulinastatin 226.5±262.9 U/L,somatostatin 264.0±204.5 U/L)after 2 hours and 24 hours (Ulinastatin 292.4±319.6 U/L,somatostatin 282.7±293.8 U/L)post ERCP with preventive drugs,were remarkable lower than the level of team placebo(522.2±496.2 U/L,506.1±559.8 U/L, P <0.01).The level of blood serum amylase after 2 hours and 24 hours post ERCP were remarkable higher than the preoperative level.Conclusion Ulinastatin could effectively prevent and cure to post ERCP pancreatits through lessening excretion dose and concentration of pancreatic juice.