| Objective:Retrospectively analyzed the incidence of postoperative complications of ERCP and EST in patients with cholelithiasis and investigated the clinical effect of endoscopic nasobiliary drainage (ENBD) in the prevention of postoperative complications. At the same time, statistically analyzed the clinical drug use in postoperative patients.Methods:A total of 189 patients with choledocholithiasis were collected from digestive endoscopy center of the second affiliated hospital of Kunming Medical University, and all patients were successfully received EST from February 2006 to February 2015. Among them, there were 104 patients who received ENBD (ENBD group) and 85 patients who were not accepted ENBD (control group).The incidence of postoperative complications, serum amylase levels at 4h and 24h of postoperative and hospitalization time were compared between the two groups. In the comparison of the postoperative drug use in patients of two groups, we brought in 84 patients for ENBD group and 75 patients for control group after excluded the individually general treatment, such as repressing acid to protect the stomach, maintain the function of liver, fluid infusion and so on. At the same time, statistically analysis the drug use of 46 patients who suffered postoperative complications of ERCP.Results: 1.Serum amylase levels at 4h and 24h of postoperative were significantly lower in the ENBD (124.4±88.6U/L,159.2±104.6U/L) group than those in the control group (169.7±123.8U/L,252.6±149.9U/L),the differences were statistically significant(P<0.05).The incidence rate of hyperamylasemia in the ENBD group was 12.5% (13/104) ,significantly lower than those in the control group(31.8%,27/85), the differences were statistically significant(P<0.05).2.The incidence rate of acute pancreatitis in the ENBD group was 5.7%(6/104) ,significantly lower than the control group 15.2% (13/85) , the differences were statistically significant(P<0.05). Among them there were 3 (2.9%) mild pancreatitis, 2 (1.9% ) moderate pancreatitis, 1 (0.9%) severe pancreatitisin the ENBD group, and 7 (8.2%) mild pancreatitis, 4 (4.7%) moderate pancreatitis, 2 (2.4%)severe pancreatitisin the control group. The incidence rate of moderate and severe acute pancreatitis in the ENBD group was significantly lower than the control group,prompted that ENBD can effectively prevent the progression of pancreatitis.3. There were 2, 3 patients who had postoperative acute cholangitis in the ENBD and control group respectively, although there was no statistically difference between two groups, the incidence rate of acute cholangitis in the ENBD group was lower than the control group.At the same time, the patients of acute cholangitis in both groups were not further developed into severe cholangitis. In addition, there was one patient suffered hemorrhageIn in the control group, and no hemorrhage, perforation, death and other serious complications happened in the ENBD group.4.The average length of stay in the ENBD group (11.0±3.20) was significantly lower than the control group (13.02±4.42),P<0.05),the differences were statistically significant(P < 0.05). The results prompted that the placement of endoscopic nasobiliary drainage can shorten the time of hospital stay.5.The mainly drug use program of two groups was antibiotics combined with somatostatin, while the use of protease inhibitors is less. And there was no significant difference in the use of antibiotics, somatostatin and protease inhibitors between the two groups (P > 0.05). In the aspect of drug use for patients who suffered postoperative acute pancreatitis of ERCP, the use of antibiotics and somatostatin in clinical practice were common. While the use of protease inhibitor was relatively less and mostly used in severe pancreatitis patients.Conclusion: 1.LENBD can effectively reduce the serum amylase level at 4h and 24h in patients who received EST for choledocholithiasis. At the same time, it can reduce the incidence rate of acute pancreatitis, hyperamylasemia and acute cholangitis. and play a certain preventive role in the progression of acute pancreatitis. In addition, ENBD can shorten the average time of hospital stay.2.The use of antibiotics and somatostatin were common for the postoperative patients in two groups, while the use of protease inhibitor was relatively less and mostly used in severe pancreatitis patients. In addition,there was no significant difference between two groups in the aspect of postoperative drug use.3.Antibiotics and somatostatin were usually adopted in clinical to treat the acute pancreatitis and cholangitis after EST. while protease inhibitor was rarely used. |
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