吲哚美辛栓联合胰管支架置入对术后胰腺炎高危人群的影响OACSTPCD
Effect of indomethacin suppositories combined with pancreatic duct stenting on population at high risk of postoperative pancreatitis
目的:研究吲哚美辛栓联合胰管支架置入对内镜逆行胰胆管造影术后胰腺炎(PEP)高危人群相关炎症因子及免疫功能的影响.方法:采取前瞻性研究,选取2022 年7 月至2023 年6 月接受内镜逆行胰胆管造影术治疗且存在胰腺炎高危风险的234 例患者作为研究对象.采用信封法分为支架组(置入胰管支架,n=80)、吲哚美辛栓组(吲哚美辛栓直肠给药,n=78)、联合组(吲哚美辛栓联合胰管支架置入,n=76).比较 3 组手术前后相关炎症因子、免疫功能、术后胰腺炎发生情况、重症胰腺炎发生率、症状缓解时间及住院时间.结果:术前3 组患者炎症因子水平、免疫功能差异无统计学意义(P>0.05).术后,联合组炎症因子白细胞介素-6、白细胞介素-10 及C-反应蛋白水平低于另两组,CD4+、CD4+/CD8+水平高于另两组,CD8+水平低于其他两组,差异有统计学意义(P<0.05);3 组PEP发生情况及重症PEP发生率差异无统计学意义(P>0.05),联合组疼痛缓解时间、住院时间短于其他两组,差异有统计学意义(P<0.05).结论:吲哚美辛栓联合胰管支架置入可降低PEP高危人群的炎症反应,提升患者免疫功能,缩短术后疼痛缓解时间与住院时间.
Objective:To investigate the effects of indomethacin suppositories combined with pancreatic duct stent implantation on inflammatory factors and immune function in patients with high risk of post endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP).Methods:In this prospective study,234 patients at high risk of PEP who received ERCP between Jul.2022 and Jun.2023 were selected as subjects.The patients were divided into stent group(pancreatic duct stent implantation,n=80),indometha-cin suppository group(rectal administration of indomethacin suppository,n=78),and combined group(indomethacin suppository com-bined with pancreatic duct stent implantation,n=76)by envelope method.The relevant inflammatory factors,immune function before or after operation,PEP occurrence,incidence of severe PEP,symptom remission time and hospital stay of the three groups were compared.Results:Before the surgery,there was no significant difference in the levels of inflammatory factors and immune function among the three groups(P>0.05).The levels of inflammatory factor interleukin-6,interleukin-10 and C-reactive protein in the combined group were lower than those in the stent group and indomethacin suppository group,the CD4+and CD4+/CD8+levels in the combined group were higher than the other two groups,and the CD8+level in the combined group was lower than the other two groups,and the differences were statistically significant(P<0.05).There was no significant difference in the occurrence of PEP and the incidence of severe PEP among the three groups(P>0.05).The duration of pain relief and hospitalization in the combined group were shorter than those in the other two groups(P<0.05).Conclusions:Indomethacin suppository and pancreatic duct stenting can reduce the inflammation of PEP high-risk population,and improve the immune function of patients.Moreover,it can shorten the postoperative pain relief time and hospi-tal stay.
金鹏飞;董源;武振东
河北中石油中心医院肝胆外科,河北 廊坊,065000
临床医学
术后胰腺炎胰胆管造影术,内窥镜逆行胰管支架吲哚美辛栓
Postoperative pancreatitisCholangiopancreatography,endoscopic retrogradePancreatic duct stentIndomethacin suppository
《腹腔镜外科杂志》 2024 (007)
492-496 / 5
河北省廊坊市科学技术研究与发展计划(2023013042)
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