吲哚美辛栓预防内镜逆行胆胰管造影术胆总管取石术后胰腺炎的研究

摘要

目的 探讨吲哚美辛栓预防内镜逆行胆胰管造影术(ERCP)胆总管取石术后胰腺炎的效果.方法 纳入2014年1-12月于民航总医院住院行ERCP胆总管取石术的胆总管结石患者51例,完全随机分为吲哚美辛组(26例)和对照组(25例).吲哚美辛组于ERCP术前60 min直肠内给予吲哚美辛栓100 mg,对照组不予吲哚美辛栓.比较2组患者术后2、6、24 h血清淀粉酶和ERCP术后胰腺炎(PEP)及高淀粉酶血症发生率.结果 吲哚美辛组术后6和24 h血清淀粉酶水平均低于对照组[(202±41) U/L比(409 ±77) U/L,(111±18) U/L比(264 ±56) U/L],差异均有统计学意义(均P＜0.05),术后2h2组间比较差异无统计学意义[(128±20) U/L比(192 ±29) U/L,P＞0.05].对照组25例患者中4例(16.0％)出现PEP,吲哚美辛组无一例出现PEP,组间差异有统计学意义(P＜0.05);对照组12例(48.0％)、吲哚美辛组7例(26.9％)出现术后高淀粉酶血症,组间差异有统计学意义(P＜0.05).结论 直肠应用吲哚美辛栓可以预防ERCP胆总管取石术后胰腺炎和高淀粉酶血症.%Objective To investigate the effect of indomethacin in preventing post-endoscopic retrograde cannulation (ERCP) pancreatitis (PEP) in patients undergoing common bile duct cholecystolithotomy.Methods Totally 51 patients with common bile duct stones who underwent ERCP common bile duct cholecystolithotomy from January 2014 to December 2014 were randomly divided into indomethacin group (26 cases) and control group (25 cases).Indomethacin group was rectally administrated with indomethacin (100 mg) 60 min before operation and control group was not given indomethacin.The serum amylase was detected 2,6 and 24 h after operation,the incidences of PEP and postoperative hyperamylasemia were compared between groups.Results The serum amylase level in indomethacin group was significantly lower than that in control group 6 and 24hafterERCP [(202±41) U/Lvs (409 ±77) U/L,(111±18) U/L vs (264 ±56) U/L] (P＜0.05),while it was not significantly different between indomethacin group and control group 2 h after ERCP [(128 ± 20) U/L vs (192 ± 29) U/L] (P ＞0.05).Totally 16.0％ (4/25) in control group and 0.0％ (0/26) in indomethacin group had PEP,48.0％ (12/25) in control group and 26.9％ (7/26) in indomethacin group had hyperamylasemia,both being significantly different between groups (P ＜ 0.05).Conclusion Rectal administration of indomethacin can prevent PEP and postoperative hyperamylasemia in patients who underwent ERCP common bile duct stone cholecystolithotomy.