Prevention EffectofPost-ERCPPancreatitis inHigh-risk Patients Using Pancreatic Duct Stentand Diclofenac/YANG Qian， XIONG Shaomin， SHAO Wenhua， FENG Qingyan.//Medical Innovation of China，2025，22（19）：112-116

[Abstract]Objective： To explore the preventive efect of pancreatic duct stents and Diclofenac on postendoscopic retrograde cholangiopancreatography （ERCP） pancreatitis in'high-risk populations，and to evaluate its impacton clinical indicators.Method： A totalof 212 post-ERCP pancreatitis in high-risk patients at Jiujiang NO.1 People's Hospital from January 2O22 to January 2O24 were included in the study.They were randomlydivided into the combined group （pancreatic duct stent + Diclofenac suppository） and the Diclofenac group， with 1O6 patients in each group.The pancreatic duct stent used was a short stent of 4-7 cm，and Diclofenac was administered at 50 mg via rectal administration at1h before and after the surgery in the Diclofenac group.The incidence of post-ERCP pancreatitis，VAS scores，length ofhospital stay，serumamylase levels，WBC，CRP，andERCP-related complications were observed and compared between the two groups.Result： The number of people without pancreatitis in the combined group was greaterthanthatinthe Diclofenac group，and thelengthof hospital stay wasshorterthanthat in theDiclofenac group（ P lt;0.05）.Therewas no statistically significant difference in the VAS score between the two groups （ P gt;0.05）.At 24 h after the operation，the levels of serum amylase and CRP in both groups increased， the levels of serum amylase and CRP in the combined group were lower than those in the Diclofenac group （ P lt;0.05）. There was no statistically significant difference within and between the two groups of WBC （ P_* gt;0.05）. The incidence of complications in the combined group was 2.83% ， which was lower than 13.21% in the Diclofenac group （ P lt;0.05）. Conclusion： The combination of pancreatic duct stent and Diclofenac can synergistically reduce the incidence and severityof pancreatitis inhigh-riskpatients，improve inflammatory markers，shorten hospitalstays，notsignificantly increase pain，and reduce ERCP-related complications.It is recommended as afirst-line preventive strategy for post-ERCP pancreatitis.

[Key words]Endoscopic retrograde cholangiopancreatographyPancreatitisPancreatic duct stent Diclofenac High-risk population Preventive effect

First-author's address： Department of Gastroenterology， Jiujiang NO.1 People's Hospital， Jiujiang 332000， China

doi：10.3969/j.issn.1674-4985.2025.19.026

尽管内镜逆行胰胆管造影（ERCP）已广泛应用于临床，但其术后并发症仍是影响患者预后和术后恢复的重要因素。如何在高危人群中有效预防ERCP术后胰腺炎，已成为临床研究的重点。术后胰腺炎在高危人群中的发生率可攀升至15%～20% ，导致医疗费用增加1.8＼～3.5倍，重症患者死亡率达 2%～5%^[1] 。现有预防体系面临双重困境：其一，传统机械预防措施（如胰管支架）虽可降低内镜逆行胰胆管造影术后胰腺炎（post-ERCPpancreatitis，PEP）风险（ RR=0.35 ），但其获益受限于支架移位率（ 8.2% ）及操作者经验差异（成功率72%～93% ）；其二，药物预防方案中，直肠双氯芬酸虽被纳入国际指南[2，但其对高危人群的预防效力存在天花板效应，且可能诱发消化道出血[。因此，寻找新的、有效的预防方案势在必行。胰管支架近年来的应用在预防PEP方面取得了一定的进展，然而单纯依靠胰管支架的应用效果并不总是理想。已有研究表明，双氯芬酸可通过抑制胰腺中的环氧合酶（COX）活性，减少炎症介质的释放，从而减轻术后胰腺炎的发生[4。然而，单独使用双氯芬酸也未能完全解决术后胰腺炎的预防问题。本研究旨在通过对比胰管支架和双氯芬酸联合治疗与常规治疗在ERCP术后高危人群中的应用效果，为临床提供更为科学的预防方案，以降低ERCP术后并发症，促进患者的术后康复。

1资料与方法

1.1一般资料

研究纳入2022年1月一2024年1月九江市第一人民医院PEP高危患者212例。纳入标准：（1）诊断为PEP高危人群（既往有急性胰腺炎病史、合并胆囊结石或胆道梗阻、慢性胰腺炎、合并高脂血症或糖尿病、胰腺肿瘤、ERCP操作难度大）[5]；……