直肠用双氯芬酸预防内镜逆行胰胆管造影术后胰腺炎。
Rectal diclofenac for prevention of post-endoscopic retrograde cholangiography pancreatitis.
机构信息
Hepato-Bilio-Pancreatic Surgery Team, Department of Surgery, Traumatology and Anesthesiology, Universidad de la Frontera, Temuco, Chile; Hepato-Bilio-Pancreatic Surgery Team, Hernán Henríquez Aravena Hospital, Temuco, Chile; Hepato-Bilio-Pancreatic Surgery Team, Clínica Alemana Temuco, Temuco, Chile.
Hepato-Bilio-Pancreatic Surgery Team, Department of Surgery, Traumatology and Anesthesiology, Universidad de la Frontera, Temuco, Chile.
出版信息
Ann Palliat Med. 2021 Feb;10(2):1336-1341. doi: 10.21037/apm-19-395. Epub 2020 Sep 30.
BACKGROUND
Acute pancreatitis is an important complication of endoscopic retrograde cholangiography (ERC), occurring between 1-10% of patients. Several randomized controlled trials and meta-analyses have demonstrated the effectiveness of nonsteroidal anti-inflammatories (NSAIDs) such as diclofenac and indomethacin as a post-ERC pancreatitis (PEP) prophylaxis. The aim is to determine if the rectal diclofenac use reduces the PEP rate.
METHODS
Retrospective cohort study. Subjects were included who underwent ERC for different indications in a tertiary center between January 2015 and June 2016. Two groups were analyzed: group A (without diclofenac use) and group B (with use of diclofenac as PEP prophylaxis). Biodemographic, technical and mortality variables were measured.
RESULTS
The total cohort was 116 patients, 67 in group A and 49 in group B. The average age was 61.9±17.8 and 58.3±15.8 years, respectively (P=0.2606). Gender distribution showed a women predominance in both groups (P=0.933). Of the technical variables measured, the precut showed a statistically significant relationship to PEP (P=0.013). Of the total cohort, 8.6% developed acute pancreatitis after an ERC: four in group A and six in group B (P=0.196). In those who developed PEP (n=10), six patients developed severe acute pancreatitis (SAP). The average hospitalization for PEP was 32.2±34 days (P=0.881). No patients died, not were there any adverse reactions to the drug.
CONCLUSIONS
Rectal diclofenac administered at the beginning of the ERC did not reduce the PEP rate in this patients cohort.
背景
内镜逆行胰胆管造影术（ERC）的一个重要并发症是急性胰腺炎，发生率为 1-10%。几项随机对照试验和荟萃分析已经证明了非甾体抗炎药（NSAIDs）如双氯芬酸和吲哚美辛作为预防 ERC 后胰腺炎（PEP）的有效性。本研究旨在确定直肠使用双氯芬酸是否能降低 PEP 发生率。
方法
回顾性队列研究。纳入 2015 年 1 月至 2016 年 6 月期间在一家三级中心因不同适应证接受 ERC 的患者。分析了两组：A 组（未使用双氯芬酸）和 B 组（使用双氯芬酸作为 PEP 预防）。测量了生物人口统计学、技术和死亡率变量。
结果
总队列共 116 例患者，A 组 67 例，B 组 49 例。平均年龄分别为 61.9±17.8 和 58.3±15.8 岁（P=0.2606）。两组均以女性为主（P=0.933）。在所测量的技术变量中，预切开与 PEP 有统计学显著关系（P=0.013）。总队列中，8.6%的 ERC 后发生急性胰腺炎：A 组 4 例，B 组 6 例（P=0.196）。在发生 PEP 的患者（n=10）中，有 6 例发生重症急性胰腺炎（SAP）。PEP 的平均住院时间为 32.2±34 天（P=0.881）。无患者死亡，也无药物不良反应。
结论
在本患者队列中，在 ERC 开始时直肠给予双氯芬酸并未降低 PEP 发生率。
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