乌司他丁预防内镜逆行胰胆管造影术后胰腺炎的系统评价

Infusion of ulinastatin via the pancreatic duct for prophylaxis of pancreatic injury after endoscopic retrograde cholangiopancreatography in dogs

AIM: To evaluate the prophylactic effect of infusion of ulinastatin via the pancreatic duct on pancreatic injury after endoscopic retrograde cholangiopancreatography (ERCP) in a canine model.

METHODS: Twenty-four dogs were randomized into three groups: ulinastatin group (group A), iobitridol group (group B) and normal group (group C). A duodenoscope was routinely inserted to the duodenal papilla under general anesthesia in dogs of each group. A guide wire was introduced into the bile duct in groups A and B to inject 10.0 mL of iobitridol, and the guide wire was then introduced into the pancreatic duct to slowly administer 100 000 units of ulinastatin and 8.0 mL of sodium chloride in group A and 10.0 mL of sodium chloride in group B. Five minutes later, 10.0 mL of iobitrdol was transfused into the pancreatic ducts in both groups within less than 1 min. A guide wire was introduced into the bile duct in group C to administer 10.0 mL of iobitridol. The contents of serum IL-6, IL-8, amylase and plasma TAP were determined by ELISA. Pancreatic tissues were pathologically examined 6 days after ERCP.

RESULTS: The contents of serum IL-6, IL-8, amylase and plasma TAP were significantly lower in group A than in group B (391.0 U/L ± 67.2 U/L vs 1 077.0 U/L ± 246.1 U/L, 51.91 ng/L ± 4.87 ng/L vs 78.11 ng/L ± 11.25 ng/L,

4.070 μg/L ± 0.089 μg/L vs 4.520 μg/L ± 0.195 μg/L, 3.234 nmol/L ± 0.185 nmol/L vs

4.001 nmol/L ± 0.237 nmol/L (all P < 0.05), and significantly higher in groups A and B than in group C. Under light microscopy, the pathological changes in pancreatic tissues in the ulinastatin group were less significant than those in other groups.

CONCLUSION: Pancreatic injury induced by ERCP could be ameliorated effectively and safety by infusion of ulinastatin via the pancreatic duct in dogs.

Efficacy of ENBD in the prevention of post-ERCP pancreatitis and hyperamylasemia in patients with common bile duct stones: an analysis of 65 cases

AIM: To investigate the value of endoscopic nasobiliary drainage (ENBD) in the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and hyperamylasemia in patients with common bile duct stones.

METHODS: The clinical data of 141 patients with common bile duct stones, including 65 undergoing ENBD and 77 undergoing routine treatment, were retrospectively reviewed. The efficacy and complication rate were compared between the two groups.

RESULTS: Serum amylase levels at 2 and 24 h postoperatively were significantly lower in the ENBD group than in the routine treatment group (67.3 U/L ± 9.1 U/L vs 98.3 U/L ± 11.2 U/L, 89.5 U/L ± 13.0 U/L vs 126.2 U/L ± 14.2 U/L, both P < 0.01). The incidence of post-ERCP pancreatitis and hyperamylasemia was also significantly lower in the ENBD group than in the routine treatment group.

CONCLUSION: ENBD can effectively prevent the occurrence of post-ERCP pancreatitis and hyperamylasemia in patients with common bile duct stones.