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摘要: 目的 对比经内镜鼻胆管引流术(ENBD)、内镜下乳头括约肌球囊扩张术(EPBD)、ENBD与EPBD联用在内镜逆行胰胆管造影术(ERCP)治疗中的疗效差异。方法 回顾性分析徐州医科大学附属医院在2019年1月—2021年12月行治疗性ERCP成功的住院患者670例，根据手术处理方案将研究对象分成ENBD组、EPBD组及联合组(ENBD+EPBD组)。比较3组手术时间、住院时间、术后3 h及24 h血清淀粉酶情况，统计术后并发症发生情况及发生率、术后症状缓解时间。结果 ENBD+EPBD组手术时间及住院时间与ENBD组、EPBD组进行比较，差异有统计学意义(均P< 0.05)；EPBD组手术时间及住院时间与ENBD组进行比较，差异有统计学意义(均P< 0.05)。在术后3 h及24 h血淀粉酶水平方面，3组对比差异有统计学意义(P< 0.05)；在术后症状缓解时间上，ENBD+EPBD组术后症状缓解时间短于其余2组，差异有统计学意义(均P< 0.05)；EPBD组与ENBD组进行比较，EPBD组术后症状缓解时间短于ENBD组，差异有统计学意义(P< 0.05)。结论 ENBD与EPBD联用方案安全性好，能更好地降低术后血清淀粉酶指标、缩短住院时间及促进术后症状恢复，并且不会明显增加手术时间。建议在进行ERCP术中采取ENBD联合EPBD的治疗方案。
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关键词:
- 鼻胆管引流 /
- 乳头球囊扩张 /
- 内镜逆行胰胆管造影术 /
- 术后胰腺炎 /
- 高淀粉酶血症
Abstract: Objective To compare the therapeutic effects of endoscopic nasobiliary drainage(ENBD) alone, endoscopic sphincter balloon dilation(EPBD) alone, and ENBD combined with EPBD during the trentment with ERCP.Methods A retrospective analysis was performed on 670 inpatients who were successfully treated with ERCP in the Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2021. The patients were grouped according to the surgical treatment plans, for example, only ENBD was performed during ERCP, and the subjects were included in the ENBD group. EPBD was used during ERCP, and subjects were included in the EPBD group. If ERCP was combined with ENBD and EPBD, subjects were included in the combined group(ENBD+EPBD group). The operation time, hospital stay, serum amylase levels at 3 h and 24 h after surgery were compared among the three groups, and the incidence of postoperative complications and postoperative symptom relief time were counted.Results The operative time and length of hospital stay in ENBD+EPBD group were compared with ENBD group and EPBD group, and the differences were statistically significant(allP< 0.05). The operative time and length of hospital stay in the EPBD group were compared with those of the ENBD group, and the differences were statistically significant(allP< 0.05). There were statistically significant differences in serum amylase levels at 3 h and 24 h after operation among the three groups(P< 0.05). In terms of postoperative symptom relief time, the postoperative symptom relief time of ENBD+EPBD group was shorter than the other two groups, and the difference was statistically significant(allP< 0.05). Compared with ENBD group, the postoperative symptom relief time of EPBD group was shorter than that of ENBD group, and the difference was statistically significant(P< 0.05).Conclusion ENBD combined with EPBD has good safety, can better promote the decrease of postoperative serum amylase index, shorten the length of hospital stay and promote the recovery of postoperative symptoms, and will not significantly increase the operation time. A treatment plan of ENBD combined with EPBD is recommended in ERCP operation. -
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表 1 3组患者一般资料比较
例 指标 ENBD组
(n=246)EPBD组
(n=172)ENBD+EPBD组
(n=252)F/χ2 P 性别 3.575 0.167 男 141 85 126 女 105 87 126 平均年龄/岁 65.39±16.36 66.49±16.90 64.58±15.86 0.704 0.495 术前诊断 11.51 0.074 胆总管结石 155 126 183 胆囊结石 28 19 27 急性胰腺炎 18 9 18 其他类型 45 18 24 既往胆囊切除史 47 40 50 1.163 0.559 既往ERCP手术史 21 9 12 3.441 0.179 糖尿病 15 13 18 0.386 0.824 高血压 59 46 67 0.582 0.748 胆总管结石数目 3.321 0.768 泥沙样结石 42 29 49 1个结石 58 43 76 2个结石 16 13 13 >2个结石 111 79 110 胆总管结石位置 5.516 0.238 胆总管上段 23 15 21 胆总管中段 88 78 108 胆总管下段 116 71 119 胆总管结石最大直径/mm 8.28±4.77 8.15±4.76 7.41±3.86 2.610 0.115 
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表 2 3组手术时间及住院时间比较
X±S 组别 手术时间/min 住院时间/d ENBD组 57.71±18.35 11.57±6.07 EPBD组 60.87±22.051) 9.51±7.331) ENBD+EPBD组 59.11±21.141) 7.42±3.001)2) P 0.296 < 0.001 与ENBD组比较，1)P < 0.05；与EPBD组比较，2)P < 0.05。
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表 3 3组患者术后血淀粉酶比较
U/L，X±S 组别 例数 血淀粉酶 术后3 h 术后24 h ENBD组 246 198.36±18.74 181.43±17.62 EPBD组 172 243.02±38.38 189.48±19.16 ENBD+EPBD组 252 132.72±10.301)2) 117.76±9.471)2) P 0.181 0.179 与ENBD组比较，1)P < 0.05；与EPBD组比较，2)P < 0.05。
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表 4 3组患者术后并发症比较
例(%) 组别 例数 术后并发症 术后胰腺炎 高淀粉酶血症 消化道出血 胆道出血 穿孔 感染 ENBD组 246 12(4.9) 37(15.0) 1(0.41) 2(0.81) 2(0.81) 11(4.47) EPBD组 172 20(11.6) 38(22.1) 4(2.33) 6(3.49) 1(0.58) 15(8.72) ENBD+EPBD组 252 5(2.0) 22(8.7) 2(0.79) 2(0.79) 0 5(1.98) χ2 18.532 14.843 25.491 P < 0.001 0.001 0.001
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表 5 3组患者术后症状缓解时间
d，X±S 组别 例数 术前相关症状缓解时间 腹痛 黄疸 食欲减退 ENBD组 246 3.45±0.14 5.17±0.42 3.53±0.44 EPBD组 172 2.77±0.131) 4.63±0.661) 3.81±0.57 ENBD+EPBD组 252 1.45±0.061)2) 2.23±0.341)2) 2.06±0.221)2) P < 0.001 < 0.001 0.009 与ENBD组比较，1)P < 0.05；与EPBD组比较，2)P < 0.05。
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| 引用本文: |
肖耀东, 费素娟. ENBD与EPBD单用或联用的临床效果分析[J]. 中国中西医结合消化杂志, 2022, 30(6): 389-393. doi: 10.3969/j.issn.1671-038X.2022.06.02
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| Citation: |
XIAO Yaodong, FEI Sujuan. Clinical effect analysis of ENBD and EPBD alone or in combination[J]. Chin J Integr Tradit West Med Dig, 2022, 30(6): 389-393. doi: 10.3969/j.issn.1671-038X.2022.06.02
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