舒宏春 练火军 诸葛群 周卫萍 郑美虹 邓辉球

[摘要]目的 探讨术前肠道去污对于预防内镜下逆行胰胆管造影术（ERCP）术后患者急性胰腺炎和高淀粉酶血症的疗效。方法 选取2019年1月～2020年1月在我院进行ERCP治疗的110例患者作为研究对象，依据随机数字表法将入选对象分为试验组与对照组，每组各55例。两组均行ERCP，试验组患者于术前晚七点口服复方聚乙二醇电解质散剂2000 ml行肠道去污处理，对照组患者口服清水2000 ml。检测两组术前及术后24 h的白细胞（WBC）、丙氨酸氨基转移酶（ALT）、血清总胆红素（TBil）水平，记录两组患者术后急性胰腺炎和高淀粉酶血症的发病率，比较两组患者的术后排便时间、腹痛评分、住院时间、医疗费用，观察两组患者住院期间的转归及其他并发症发生情况。结果 两组患者术后24 h的WBC、ALT、TBil水平低于术前，差异有统计学意义（P<0.05）;试验组患者术后24 h的WBC、ALT、TBil水平低于对照组，差异有统计学意义（P<0.05）。试验组患者ERCP术后急性胰腺炎和高淀粉酶血症发病率均低于对照组，差异有统计学意义（P<0.05）。试验组患者的术后排便时间、住院时间短于对照组，腹痛评分低于对照组，医疗费用少于对照组，差异有统计学意义（P<0.05）。试验组患者治愈出院率高于对照组，死亡率低于对照组，差异有统计学意义（P<0.05）。试验组患者的感染、术后出血发生率低于对照组，差异有统计学意义（P<0.05）。结论 通过术前肠道去污可以减少ERCP术后急性胰腺炎的发病率，减轻患者术后腹痛等不适，改善患者预后，降低医疗费用，值得临床应用。

[关键词]术前肠道去污;急性胰腺炎;內镜下逆行胰胆管造影术;高淀粉酶血症

[中图分类号] R576          [文献标识码] A          [文章编号] 1674-4721（2020）7（a）-0042-04

Prospective randomized controlled study of preoperative intestinal decontamination in the prevention of acute pancreatitis after ERCP

SHU Hong-chun   LIAN Huo-jun   ZHUGE Qun   ZHOU Wei-ping   ZHENG Mei-hong   DENG Hui-qiu

Department of Gastroenterology， Shangrao People′s Hospital of Jiangxi Province， Shangrao   334000， China

[Abstract] Objective To investigate the curative effect of preoperative intestinal decontamination on preventing acute pancreatitis and hyperamylasemia in patients undergoing endoscopic retrograde cholangiopancreatography （ERCP）. Methods Altogether 110 patients who underwent ERCP in our hospital from January 2019 to January 2020 were selected as the study subjects. According to the random number table method， the subjects were divided into the experimental group and the control group， 55 cases in each group. ERCP was performed in both groups. The experimental group was given Compound Polyethylene Glycol Electrolyte Powder 2000 ml orally at 7 pm before operation， and the control group was given clear water 2000 ml orally. The levels of WBC， ALT and TBil were measured before and 24 hours after operation. The incidence of acute pancreatitis and hyperamylasemia was recorded between the two groups. The defecation time， abdominal pain score， hospitalization time and medical expenses were compared between the two groups. The prognosis during hospitalization and other complications were observed between the two groups. Results The levels of WBC， ALT and TBil at 24 hours after operation in the two groups were lower than those before operation， and the differences were statistically significant （P<0.05）. The levels of WBC， ALT and TBil 24 hours after operation in the experimental group were lower than those in the control group， with significant differences （P<0.05）. The incidence of acute pancreatitis and hyperamylasemia after ERCP in the experimental group was lower than that in the control group， with significant difference （P<0.05）. Postoperative defecation time and hospitalization time of the experimental group were shorter than those of the control group， abdominal pain score was lower than that of the control group， and medical expense was lower than that of the control group， with significant differences （P<0.05）. The cure discharge rate of the experimental group was higher than that of the control group， and the mortality of the experimental group was lower than that of the control group， and the differences were statistically significant （P<0.05）. The incidence of infection and bleeding after operation in the experimental group was lower than that in the control group， with significant difference （P<0.05）. Conclusion Preoperative intestinal decontamination can reduce the incidence of acute pancreatitis after ERCP， alleviate postoperative abdominal pain and other discomforts， improve the prognosis of patients and reduce medical costs， which is worthy of clinical application.

[Key words] Preoperative intestinal decontamination; Acute pancreatitis; Endoscopic retrograde cholangiopancreatography; Hyperamylasemia

内镜下逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）是诊断和治疗胆道及胰腺疾病的一种重要的微创胆胰疾病治疗技术，但术中及术后并发症的发生在一定程度上制约了其被广泛开展及推广[1-3]。ERCP术后急性胰腺炎是最常见的、最严重的并发症，在急性胰腺炎的治疗中，由于肠道去污可以促进通便，减轻腹腔室隔综合征，抑制炎症介质和细胞因子的产生及肠道有害菌的滋生，减少菌群异位风险等，因此，其可以促进胰腺炎的恢复[4-6]。然而，临床关于术前进行肠道去污是否具有预防ERCP术后急性胰腺炎效果的报道较少。……