ERCP术后胰腺炎预防的研究现状

发布时间：2018-06-17 07:33

  本文选题：内镜逆行胰胆管造影术 + 急性胰腺炎　； 参考：《南昌大学》2017年硕士论文

【摘要】：背景:内镜技术是医学发展最为迅速的技术之一,近年来随着内镜器械及技术的日益发展,ERCP及其相关技术已广泛应用于胆胰疾病的诊疗,其具有疗效好、创伤小、并发症少、明显改善患者预后等优势;但是作为一种侵入性的有创操作,它同时会产生许多的并发症,其中胰腺炎是其最常见、最严重的并发症,这在某种程度上可能限制了该技术的广泛应用与发展;因此,如何降低ERCP术后胰腺炎的发生率、减轻其严重程度至关重要。目的:通过综述目前ERCP术后胰腺炎预防策略的研究现状,总结预防ERCP术后胰腺炎的可行方案,为其在临床实践中安全、高效的应用提供一定的参考。方法:以“内镜逆行胰胆管造影术、急性胰腺炎、ERCP术后胰腺炎、预防、并发症”等检索词进行检索,找出预防ERCP术后胰腺炎相关的研究。结果与结论:对于ERCP术后胰腺炎的预防首先应当严格的筛选病人,掌握其适应症,避免行诊断性ERCP,对于疑似胆总管结石的患者可行EUS/MRCP等更加安全有效的方法代替;其次评估患者相关危险因素,并适当的直肠给予非甾体消炎药;技术层面上可以使用导丝引导插管,尽量减少插管的次数,避免注射造影剂或者直接损伤胰管,同时临时放置胰管支架等也可减少ERCP术后胰腺炎的发生。
[Abstract]:Background: endoscopic technology is one of the most rapidly developing technologies in medicine. In recent years, with the development of endoscopic instruments and techniques, ERCP and its related technologies have been widely used in the diagnosis and treatment of biliary and pancreatic diseases. But as an invasive procedure, it can produce many complications at the same time, among which pancreatitis is the most common and serious complication. To some extent, this may limit the wide application and development of this technique; therefore, it is important to reduce the incidence and severity of pancreatitis after ERCP. Objective: to summarize the present research status of prevention strategy of post-ERCP pancreatitis, and summarize the feasible plan of prevention of post-ERCP pancreatitis, and provide some reference for its safe and efficient application in clinical practice. Methods: the key words of "Endoscopic retrograde cholangiopancreatography, acute pancreatitis after ERCP, prevention, complication" were searched to find out the related research of preventing ERCP postoperative pancreatitis. Results & conclusion: for the prevention of pancreatitis after ERCP, the patients should be screened strictly, their indications should be grasped, and diagnostic ERCPs should be avoided. More safe and effective methods such as EUS-MRCP could be used in patients suspected of choledocholithiasis. Secondly, evaluate the risk factors of the patients, and give appropriate non-steroidal anti-inflammatory drugs to the rectum. At the technical level, we can use the guide wire to guide the intubation, to minimize the times of intubation, and to avoid injecting contrast agent or directly damaging the pancreatic duct. At the same time temporary placement of pancreatic stents can also reduce the incidence of post-ERCP pancreatitis.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576

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