胰管支架联合吲哚美辛栓对困难胆管插管术后胰腺炎的预防作用分析

Pancreatic duct stent combined with indomethacin suppository for prevention of pancreatitis after difficult bile duct intubation during endoscopic retrograde cholangiopancreatography

摘要:

目的 探索胰管支架联合吲哚美辛栓直肠给药对内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography， ERCP）困难插管术后胰腺炎（post‑ERCP pancreatitis， PEP）的预防作用。方法 2019年1月—2021年12月在南京医科大学附属杭州医院行ERCP治疗的胆道疾病患者术前30 min予吲哚美辛栓100 mg纳肛，将术中发生困难胆管插管的患者（n=204）纳入本研究。根据随机数字数表将患者分为两组，联合组术中置入胰管支架（n=104），吲哚美辛组不置入支架（n=100）。比较两组术后高淀粉酶血症及PEP的发生率。结果 联合组术后高淀粉酶血症［21.2%（22/104）比34.0%（34/100），χ2=4.22，P=0.040］及PEP发生率［14.4%（15/104）比32.0%（32/100），χ2=8.88，P=0.003］均明显低于吲哚美辛组，但两组重症PEP发生率之间差异无统计学意义［1.0%（1/104）比1.0%（1/100），χ2=0.001，P=0.978］。结论 与单用吲哚美辛栓直肠给药相比，联合胰管支架置入可进一步减少ERCP后高淀粉酶血症和PEP的发生。

Abstract:

Objective To explore the preventive effects of pancreatic duct stent combined with rectal administration of indomethacin suppository for post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after difficult bile duct intubation during endoscopic retrograde cholangiopancreatography (ERCP). Methods From January 2019 to December 2021, patients with biliary and pancreatic diseases undergoing ERCP in Hangzhou Hospital Affiliated to Nanjing Medical University were given 100 mg indomethacin suppository to anal canal 30 minutes before the operation. And those with difficult bile duct intubation during the operation (n=204) were included in this study. According to the random number table, they were divided into the combination group (implanted with pancreatic duct stent during the operation, n=104) and the indomethacin group (not implanted with stent, n=100). The incidences of hyperamylasemia and PEP were compared between the two groups. Results The incidences of postoperative hyperamylasemia [21.2% (22/104) VS 34.0% (34/100), χ2=4.22, P=0.040] and PEP [14.4% (15/104) VS 32.0% (32/100), χ2=8.88, P=0.003] in the combination group were significantly lower than those in the indomethacin group. There was no significant difference in the incidence of severe PEP between the two groups [1.0% (1/104) VS 1.0% (1/100),χ2=0.001, P=0.978]. Conclusion Compared with rectal administration of indomethacin suppository alone, the incidences of hyperamylasemia and PEP after difficult bile duct intubation during ERCP can be further reduced when it is combined with pancreatic duct stent placement.