經內鏡胰管支架置入在預防ERCP術后胰腺炎高危患者中的臨床應用_《中國普外基礎與臨床雜志》

作者：

李汛 , 朱曉亮 , 周文策 , 孟文勃 , 張磊 , 張輝 , 李瓊 , 蒲小金 , 陳英 , 徐冬霞

蘭州大學第一醫院普外二科ERCP診療中心，甘肅省消化系腫瘤重點實驗室（蘭州 730030）;

關鍵詞：

胰管支架經內鏡逆行胰膽管造影 ERCP術后胰腺炎

視頻：

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目的　探討經內鏡胰管支架置入在預防ERCP術后胰腺炎（PEP）高危患者中的作用。
方法　回顧性分析我院2005年1月至2010年6月期間行ERCP及相關治療的112例PEP高危患者的臨床資料，根據術中是否留置胰管支架分為留置支架組（52例）和未留置支架組（60例）。以Cotton標準診斷PEP。比較2組患者PEP及重癥PEP的發生率及PEP發生的高危因素。
結果　留置支架組發生PEP 3例（5.8%），均于術后48 h癥狀、體征消失，且無一例診斷為重癥PEP；未留置支架組發生PEP 9例（15.0%），2例診斷為重癥PEP，經予禁食、抑酶、抗炎、腸內營養等對癥、支持治療好轉。留置支架組PEP和重癥PEP的發生率明顯低于未留置支架組（P lt;0.05）。進一步分析發現，年輕（≤45歲）女性、奧狄括約肌功能障礙（SOD）及膽管不擴張患者易發生PEP（P lt;0.05）。
結論　在PEP高危患者行ERCP治療中置入胰管支架，可明顯降低PEP的發生率。

引用本文： 李汛,朱曉亮,周文策,孟文勃,張磊,張輝,李瓊,蒲小金,陳英,徐冬霞. 經內鏡胰管支架置入在預防ERCP術后胰腺炎高危患者中的臨床應用. 中國普外基礎與臨床雜志, 2010, 17(10): 1006-1009. doi: 復制

1.	李汛, 李玉民, 梁聚民, 等. 端粒酶基因和DNA倍體在良惡性梗阻性黃疸中的表達 [J]. 中國普外基礎與臨床雜志, 2007; 14(5): 531-532.
2.	蘇進根, 王建平, 楊廷燕. 十二指腸鏡技術在腹腔鏡膽囊切除術前術后的應用經驗 [J]. 中國普外基礎與臨床雜志, 2005; 12(4): 343-345.
3.	Freeman ML. Prevention of post-ERCP pancreatitis: pharmacologic solution or patient selection and pancreatic stents? [J]. Gastroenterology, 2003; 124(7): 1977-1980.
4.	Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc, 1991; 37(3): 383-393.
5.	李汛, 朱曉亮, 沈亦萱, 等. 鎮靜、鎮痛麻醉在治療性ERCP中的安全性評估及應用 [J]. 中國普外基礎與臨床雜志, 2009; 16(8): 645-648.
6.	徐福濤. 內鏡術的鎮靜與麻醉 [J]. 中華消化內鏡雜志, 2002; 19(6): 325-326.
7.	潘小平, 黨彤. 胰管支架置入術預防ERCP術后胰腺炎研究進展 [J]. 中國實用內科雜志, 2009; 29(9): 852-853.
8.	Andriulli A, Loperfido S, Napolitano G. Incidence rates of postERCP complications: a systematic survey of prospective studies [J]. Am J Gastroenterol, 2007; 102(8): 1781-1788.
9.	Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study [J]. Gastrointest Endosc, 2001; 54(4): 425-434.
10.	Sherman S, Lehman GA. ERCP- and endoscopic sphincterotomy-induced pancreatitis [J]. Pancreas, 1991; 6(3): 350-367.
11.	Bailey AA, Bourke MJ, Williams SJ, et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis [J]. Endoscopy, 2008; 40(4): 296-301.
12.	Sherman S, Blaut U, Watkins JL, et al. Does prophylactic administration of corticosteroid reduce the risk and severity of post-ERCP pancreatitis: a randomized, prospective, multicenter study [J]. Gastrointest Endosc, 2003; 58(1): 23-29.
13.	Saad AM, Fogel EL, McHenry L, et al. Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results [J]. Gastrointest Endosc, 2008; 67(2): 255-261.
14.	Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials [J]. Gastrointest Endosc, 2004; 60(4): 544-550.
15.	Tarnasky PR, Palesch YY, Cunningham JT, et al. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction [J]. Gastroenterology, 1998; 115(6): 1518-1524.
16.	潘濤, 王一平, 楊錦林, 等. 胰管支架置入術預防內鏡逆行胰膽管造影術后胰腺炎的系統評價 [J]. 中國循證醫學雜志, 2004; 4(10): 693-699.
17.	Andriulli A, Forlano R, Napolitano G, et al. Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: a systematic analysis of benefits and associated risks [J]. Digestion, 2007; 75　(2-3): 156-163.

1. 　李汛, 李玉民, 梁聚民, 等. 端粒酶基因和DNA倍體在良惡性梗阻性黃疸中的表達 [J]. 中國普外基礎與臨床雜志, 2007; 14(5): 531-532.
2. 　蘇進根, 王建平, 楊廷燕. 十二指腸鏡技術在腹腔鏡膽囊切除術前術后的應用經驗 [J]. 中國普外基礎與臨床雜志, 2005; 12(4): 343-345.
3. 　Freeman ML. Prevention of post-ERCP pancreatitis: pharmacologic solution or patient selection and pancreatic stents? [J]. Gastroenterology, 2003; 124(7): 1977-1980.
4. 　Cotton PB, Lehman G, Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus [J]. Gastrointest Endosc, 1991; 37(3): 383-393.
5. 　李汛, 朱曉亮, 沈亦萱, 等. 鎮靜、鎮痛麻醉在治療性ERCP中的安全性評估及應用 [J]. 中國普外基礎與臨床雜志, 2009; 16(8): 645-648.
6. 　徐福濤. 內鏡術的鎮靜與麻醉 [J]. 中華消化內鏡雜志, 2002; 19(6): 325-326.
7. 　潘小平, 黨彤. 胰管支架置入術預防ERCP術后胰腺炎研究進展 [J]. 中國實用內科雜志, 2009; 29(9): 852-853.
8. 　Andriulli A, Loperfido S, Napolitano G. Incidence rates of postERCP complications: a systematic survey of prospective studies [J]. Am J Gastroenterol, 2007; 102(8): 1781-1788.
9. 　Freeman ML, DiSario JA, Nelson DB, et al. Risk factors for post-ERCP pancreatitis: a prospective, multicenter study [J]. Gastrointest Endosc, 2001; 54(4): 425-434.
10. 　Sherman S, Lehman GA. ERCP- and endoscopic sphincterotomy-induced pancreatitis [J]. Pancreas, 1991; 6(3): 350-367.
11. 　Bailey AA, Bourke MJ, Williams SJ, et al. A prospective randomized trial of cannulation technique in ERCP: effects on technical success and post-ERCP pancreatitis [J]. Endoscopy, 2008; 40(4): 296-301.
12. 　Sherman S, Blaut U, Watkins JL, et al. Does prophylactic administration of corticosteroid reduce the risk and severity of post-ERCP pancreatitis: a randomized, prospective, multicenter study [J]. Gastrointest Endosc, 2003; 58(1): 23-29.
13. 　Saad AM, Fogel EL, McHenry L, et al. Pancreatic duct stent placement prevents post-ERCP pancreatitis in patients with suspected sphincter of Oddi dysfunction but normal manometry results [J]. Gastrointest Endosc, 2008; 67(2): 255-261.
14. 　Singh P, Das A, Isenberg G, et al. Does prophylactic pancreatic stent placement reduce the risk of post-ERCP acute pancreatitis? A meta-analysis of controlled trials [J]. Gastrointest Endosc, 2004; 60(4): 544-550.
15. 　Tarnasky PR, Palesch YY, Cunningham JT, et al. Pancreatic stenting prevents pancreatitis after biliary sphincterotomy in patients with sphincter of Oddi dysfunction [J]. Gastroenterology, 1998; 115(6): 1518-1524.
16. 　潘濤, 王一平, 楊錦林, 等. 胰管支架置入術預防內鏡逆行胰膽管造影術后胰腺炎的系統評價 [J]. 中國循證醫學雜志, 2004; 4(10): 693-699.
17. 　Andriulli A, Forlano R, Napolitano G, et al. Pancreatic duct stents in the prophylaxis of pancreatic damage after endoscopic retrograde cholangiopancreatography: a systematic analysis of benefits and associated risks [J]. Digestion, 2007; 75　(2-3): 156-163.

《中國普外基礎與臨床雜志》

經內鏡胰管支架置入在預防ERCP術后胰腺炎高危患者中的臨床應用

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《中國普外基礎與臨床雜志》

經內鏡胰管支架置入在預防ERCP術后胰腺炎高危患者中的臨床應用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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