• 蘭州大學(xué)第一醫(yī)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）;

目的　 探討經(jīng)內(nèi)鏡胰管支架置入在預(yù)防ERCP術(shù)后胰腺炎（PEP）高?；颊咧械淖饔谩?br />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(guān)治療的112例PEP高?；颊叩呐R床資料，根據(jù)術(shù)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(biāo)準(zhǔn)診斷PEP。比較2組患者PEP及重癥PEP的發(fā)生率及PEP發(fā)生的高危因素。
結(jié)果 　留置支架組發(fā)生PEP 3例（5.8%），均于術(shù)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(fā)生PEP 9例（15.0%），2例診斷為重癥PEP，經(jīng)予禁食、抑酶、抗炎、腸內(nèi)營養(yǎng)等對癥、支持治療好轉(zhuǎn)。留置支架組PEP和重癥PEP的發(fā)生率明顯低于未留置支架組（P lt;0.05）。進(jìn)一步分析發(fā)現(xiàn)，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(fā)生PEP（P lt;0.05）。
結(jié)論 　在PEP高?；颊咝蠩RCP治療中置入胰管支架，可明顯降低PEP的發(fā)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(jīng)內(nèi)鏡胰管支架置入在預(yù)防ERCP術(shù)后胰腺炎高危患者中的臨床應(yīng)用. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(10): 1006-1009. doi: 復(fù)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(dá) [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(5): 531-532.
2. 　蘇進(jìn)根, 王建平, 楊廷燕. 十二指腸鏡技術(shù)在腹腔鏡膽囊切除術(shù)前術(shù)后的應(yīng)用經(jīng)驗 [J]. 中國普外基礎(chǔ)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(zhèn)靜、鎮(zhèn)痛麻醉在治療性ERCP中的安全性評估及應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(8): 645-648.
6. 　徐福濤. 內(nèi)鏡術(shù)的鎮(zhèn)靜與麻醉 [J]. 中華消化內(nèi)鏡雜志, 2002; 19(6): 325-326.
7. 　潘小平, 黨彤. 胰管支架置入術(shù)預(yù)防ERCP術(shù)后胰腺炎研究進(jìn)展 [J]. 中國實用內(nèi)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(shù)預(yù)防內(nèi)鏡逆行胰膽管造影術(shù)后胰腺炎的系統(tǒng)評價 [J]. 中國循證醫(yī)學(xué)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. 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(dá) [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(5): 531-532.
  2. 2. 　蘇進(jìn)根, 王建平, 楊廷燕. 十二指腸鏡技術(shù)在腹腔鏡膽囊切除術(shù)前術(shù)后的應(yīng)用經(jīng)驗 [J]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(4): 343-345.
  3. 3. 　Freeman ML. Prevention of post-ERCP pancreatitis: pharmacologic solution or patient selection and pancreatic stents? [J]. Gastroenterology, 2003; 124(7): 1977-1980.
  4. 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. 5. 　李汛, 朱曉亮, 沈亦萱, 等. 鎮(zhèn)靜、鎮(zhèn)痛麻醉在治療性ERCP中的安全性評估及應(yīng)用 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009; 16(8): 645-648.
  6. 6. 　徐福濤. 內(nèi)鏡術(shù)的鎮(zhèn)靜與麻醉 [J]. 中華消化內(nèi)鏡雜志, 2002; 19(6): 325-326.
  7. 7. 　潘小平, 黨彤. 胰管支架置入術(shù)預(yù)防ERCP術(shù)后胰腺炎研究進(jìn)展 [J]. 中國實用內(nèi)科雜志, 2009; 29(9): 852-853.
  8. 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. 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. 10. 　Sherman S, Lehman GA. ERCP- and endoscopic sphincterotomy-induced pancreatitis [J]. Pancreas, 1991; 6(3): 350-367.
  11. 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. 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. 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. 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. 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. 16. 　潘濤, 王一平, 楊錦林, 等. 胰管支架置入術(shù)預(yù)防內(nèi)鏡逆行胰膽管造影術(shù)后胰腺炎的系統(tǒng)評價 [J]. 中國循證醫(yī)學(xué)雜志, 2004; 4(10): 693-699.
  17. 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.