ERCP术后鼻胆管引流和抗生素灌洗的作用.docVIP

ERCP术后鼻胆管引流和抗生素灌洗的作用 　　摘要：目的 探讨鼻胆管引流和抗生素灌洗对ERCP术后并发症的影响。方法 回顾性分析自2012年1月～2015年12月共约126例ERCP患者术后放置鼻?管引流，将患者分为ENBD+甲硝唑灌洗组、ENBD+庆大霉素灌洗组、单纯ENBD组。将各组患者腹痛、发热、黄疸消退时间、血淀粉酶消退时间、胆汁引流量进行比较分析。结果 126例ERCP患者术后放置鼻胆管引流，其中ENBD+甲硝唑灌洗组40例，ENBD+庆大霉素灌洗组39例，单纯ENBD组47例。三组患者的腹痛和发热症状没有明显区别。ENBD+甲硝唑灌洗组和ENBD+庆大霉素灌洗组的黄疸消退时间及血淀粉酶消退时间短于单纯ENBD组，ENBD+甲硝唑灌洗组的血淀粉酶消退时间短于ENBD+庆大霉素灌洗组，两组抗生素灌洗组黄疸消退时间没有明显差异。在胆汁引流量方面，ENBD+甲硝唑灌洗组和ENBD+庆大霉素灌洗组的胆汁引流量低于单纯ENBD组，ENBD+庆大霉素灌洗组的胆汁引流量低于ENBD+甲硝唑灌洗组。结论 ENBD+抗生素灌洗可以促进胆总管充分引流胆汁和胰液，局部减轻胆管炎症和胰腺炎并发症。ENBD+甲硝唑灌洗的效果可能优于ENBD+庆大霉素灌洗。 　　关键词：鼻胆管引流；内镜逆行胰胆管造影；并发症 　　Abstract：Objective To discuss the influence of nasal biliary drainage and antibiotic lavage on the complication of endoscopic retrograde cholangio-pancreatography（ERCP）. Methods Retrospective analysis of 126 patients with nasal biliary drainage after ERCP from January 2012 to December 2015.Patients were divided into three groups，such as endoscopic nasal biliary drainage（ENBD） combined with metronidazole lavage，endoscopic nasal biliary drainage combined with gentamicin lavage，and endoscopic nasal biliary drainage. To comparative analyze the index such as abdominal pain，fever， fade time of jaundice，fade time of serum amylase，and amount of biliary drainage.Results Among 126 patients with nasal biliary drainage，there were 40 cases of endoscopic nasal biliary drainage（ENBD） combined with metronidazole lavage，39 cases of endoscopic nasal biliary drainage combined with gentamicin lavage，and 47cases of endoscopic nasal biliary drainage.Ther were no significantly difference among three groups.The fade time of jaundice and erum amylase of endoscopic nasal biliary drainage combined with metronidazole lavage and endoscopic nasal biliary drainage combined with gentamicin lavage were shorter than endoscopic nasal biliary drainage alone.The fade time of serum amylase of endoscopic nasal biliary drainage（ENBD） combined with metronidazole lavage was shorter than endoscopic nasal biliary drainage combined with gentamicin lavage.Th