治疗性ERCP术后鼻胆管引流预防患者术后胰腺炎的临床效果分析

摘要

目的 探讨鼻胆管引流预防治疗性内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopanereatography, ERCP)术后胰腺炎的临床效果.方法 选取2012年1月—2016年12月于陕西省核工业二一五医院行治疗性ERCP术成功的住院患者118例,采用系统性回顾法分析所有患者的临床资料,根据资料按其术后是否实施鼻胆管引流分为行鼻胆管引流组(A组)72例和未行鼻胆管引流组(B组)46例,记录所有患者的一般临床资料并统计治疗性ERCP术后胰腺炎、高淀粉酶血症等相关并发症的发生情况,并比较2组患者术后相关指标水平及并发症发生率的差异.结果 A组患者其术后血清淀粉酶及脂肪酶水平均明显低于B组,差异间均具有统计学意义(P<0.05);且2组患者术后12 h时其血清淀粉酶均较术后2 h升高,而A组患者术后24 h后降低,B组患者持续升高(P<0.05);且2组患者术后12 h和术后24 h时其脂肪酶均显著升高(P<0.05);A组患者胰腺炎等并发症发生率明显低于B组,差异间均具有统计学意义(P<0.05).结论 鼻胆管引流可明显降低治疗性ERCP术后胰腺炎等并发症的发生率,可作为临床上一种优选的引流方式.%Objective To investigate the clinical effect of nasobiliary drainage in the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography(ERCP). Methods One hundred and eighteen patients admitted to our hospital between January 2012 and December 2016 and given successful ERCP were selected as subjects. The clinical data of all these patients was analyzed by systematic review. The patients were divided into Group A of 72 cases(nasal bile duct drainage)and Group B of 46 cases(no nasobiliary drainage)according to the implementation of nasal drainage after surgery. The general clinical data of these patients was recorded and the incidence of complications such as pancreatitis and hyperamylasemia was recorded. Related indexes of these patients and the incidence of complications were compared between the two groups. Results The levels of serum amylase and lipase in Group A were significantly lower than those in Group B, and the difference was statistically significant(P<0.05). And the serum amylase of 2 groups increased when compared with that of 2 h after operation, but the A group decreased after 24 h and the B Group continued to rise (P<0.05). The lipase in the 2 groups increased significantly after 12 h and 24 h (P<0.05) in the 2 groups. The incidence of complications, such as pancreatitis, in Group A was significantly lower than that in Group B, and the difference was of statistical significance(P<0.05). Conclusion Nasal bile duct drainage can significantly reduce the incidence of complications such as pancreatitis after treatment of ERCP, which can be used as a preferred drainage method in clinical practice.