方剑锋 陈志良 沈志宏 鲁葆春

[摘要] 目的 探討吲哚美辛和胰管支架在预防经内镜逆行胰胆管造影术（ERCP）术后胰腺炎和高淀粉酶血症中的临床应用价值。 方法 纳入2018年1月至2020年6月绍兴市人民医院肝胆胰外科收治的1063例ERCP患者，分成高危、中危、低危3组，再根据随机双盲原则将高危组分成高危A、高危B、高危C 3组，中危、低危组分成中危A、B和低危A、B各2组。在术后常规处理外，对高危、中危、低危A组予吲哚美辛栓肛塞，B组仅常规处理，高危C组予胰管支架置入联合吲哚美辛栓肛塞。观察术后3、24 h的血淀粉酶及是否有胰腺炎症状体征、CT表现。结果 高危C组高淀粉酶血症发生率为56.6%，胰腺炎发生率为27.7%，较A组、B组明显下降，差异有统计学意义（P<0.001），中危A组高淀粉酶血症发生率为35.0%，胰腺炎发生率为6.5%，较B组明显下降，差异有统计学意义（P<0.001），低危A组高淀粉酶血症发生率为4.1%，胰腺炎发生率为0.6%，较B组明显下降，差异有统计学意义（P<0.05）。 结论 对于ERCP术后胰腺炎高危患者，术中胰管支架置入联合术后吲哚美辛栓肛塞能显著降低术后胰腺炎和高淀粉酶血症的发生率。对于ERCP术后胰腺炎中低危患者，术后吲哚美辛栓肛塞能显著降低术后胰腺炎和高淀粉酶血症的发生率。

[关键词] 吲哚美辛;胰管支架;PEP;高淀粉酶血症

[中图分类号] R735.37          [文献标识码] B          [文章编号] 1673-9701（2021）30-0106-05

[Abstract] Objective To investigate the clinical application value of pancreatic duct stent combined with indomethacin in preventing pancreatitis and hyperamylasemia after endoscopic retrograde cholangiopancreatography（ERCP）. Methods A total of 1063 Patients received ERCP in the Department of Hepatobiliary and Pancreatic Surgery of Shaoxing People’s Hospital from January 2018 to June 2020 were divided into three groups as the high-， medium- and low-risk group. The high-risk group were further divided into three groups as the high-risk group A， B and C， according to the randomized double-blind principle. The medium-risk group were further divided into two groups as the medium-risk group A and B. The low-risk group were further divided into two groups as the low-risk group A and B. The high-， medium- and low-risk group A were given indomethacin anal embolization， in addition to conventional postoperative treatment. The high-， medium-and low-risk group B were only given conventional treatment. The high-risk group C were given pancreatic duct stent implantation combined with indomethacin anal embolization. The levels of blood amylase at 3 and 24 h after operation， whether there were symptoms and signs of pancreatitis， and CT manifestations were observed. Results The incidences of hyperamylasemia and pancreatitis in the high-risk group C were 56.6% and 27.7%， respectively， which were significantly lower than those in the high-risk group A and B，the difference was statistically significant（P<0.001）. The incidences of hyperamylasemia and inflammation in the medium-risk group A were 35.0% and 6.5%， respectively， which were significantly lower than those in the medium-risk group B，the difference was statistically significant （P<0.001）. The incidences of hyperamylasemia and pancreatitis in the low-risk group A were 4.1% and 0.6%， respectively， which were significantly lower than those in the low-risk group B，the difference was statistically significant （P<0.05）. Conclusion For patients with high risk of pancreatitis after ERCP， intraoperative pancreatic duct stent placement combined with postoperative indomethacin anal embolization can significantly reduce the incidences of postoperative pancreatitis and hyperamylasemia. For patients with low and medium risk of pancreatitis after ERCP， postoperative indomethacin anal embolization can significantly reduce the incidences of postoperative pancreatitis and hyperamylasemia.

[Key words] Indomethacin; Pancreatic duct stent; PEP; Hyperamylasemia

经内镜逆行胰胆管造影术（Endoscopic retrograde cholangiopancreatography，ERCP）引进中国已有40多年历史，通过不断普及和发展，已成为临床诊断和治疗胆胰疾病不可或缺的重要手段，其具有诊断确切、疗效好、创伤小、副作用少等优点。……