预防ERCP术后胰腺炎，胰管支架应放置在胰体或胰尾部（译）

预防ERCP术后胰腺炎，胰管支架应放置在胰体或胰尾部（译）

目的：研究为预防ERCP术后胰腺炎的发生，胰管支架应放在什么位置。
方法：我院过去十年中有296例患者在首次ERCP过程中放置了胰管支架，本项研究共纳入147例患者，他们在诊断性ERCP的同时预防性放置了胰管支架。我们将这些患者分为两组：其中131例患者胰管支架放置在胰头部（头组），16例患者的胰管支架放置在胰腺体或者胰尾部（体/尾组）。比较两组之间的患者特点及ERCP相关因素。
结果：胰头组中胰淀粉酶的水平（p-AMY）明显高于胰体/尾部组[138.5 (7.0-2086)  vs 78.5 (5.0-1266.5),  P =0.03] 。胰（体/尾部）组中并未发生ERCP术后胰腺炎[胰头组，12例（9.2%）]。危险因素中，ERCP术后高淀粉酶（≥p-AMY 中位数，131IU/L）、手术时间≥60min [odds ratio (OR) 2.65, 95%CI: 1.17-6.02,  P = 0.02)和胰管支架置入胰头组(OR 3.80, 95%CI:1.12-12.9,  P = 0.03)被认为是多因素分析中的独立危险因素。
结论：胰管支架放置在胰体或尾部能降低ERCP术后高淀粉酶血症，可能会降低PEP的风险。
 
 
Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail
Sugimoto M, Takagi T, Suzuki R, et al. 
AIM：To investigate the location to which a pancreatic stent should be inserted to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).
METHODS：Over a ten-year period at our hospital, 296 patients under-went their first ERCP procedure and had a pancreatic stent inserted; this study included 147 patients who had ERCP performed primarily for biliary investigation and had a pancreatic stent inserted to prevent PEP. We divided these patients into two groups: 131 patients with a stent inserted into the pancreatic head (head group) and 16 patients with a stent inserted up to the pancreatic body or tail (body/tail group). Patient characteristics and ERCP factors were compared between the groups.
RESULTS：Pancreatic amylase isoenzyme (p-AMY) levels in the head group were significantly higher than those in the body/tail group [138.5 (7.0-2086)  vs 78.5 (5.0-1266.5),  P =0.03] [median (range)]. No cases of PEP were detected in the body/tail group [head group, 12 (9.2%)]. Of the risk factors for post-ERCP hyperamylasemia ( ≥ p-AMY median, 131 IU/L), procedure time  ≥ 60 min [odds ratio (OR) 2.65, 95%CI: 1.17-6.02,  P = 0.02) and stent insertion into the pancreatic head (OR 3.80, 95%CI:
1.12-12.9,  P = 0.03) were identified as independent risk factors by multivariate analysis.
CONCLUSION：Stent insertion up to the pancreatic body or tail reduces the risk of post-ERCP hyperamylasemia and may reduce the risk of PEP.

翻译：张卫  审校：张立超、侯森林  世界胃肠病学杂志(英文版), 2018