| Background and objectiveEndoscopic retrograde cholangiopancreatography(ERCP)came out in the 1960 s,and created a new field of pancreaticobiliary diseases.With the rapid development of medical imaging and medical materials in recent years,ERCP is no longer limited to "angiography",ERCP related treatment technologies such as sphincterotomy,lithotomy,dilatation,stent placement and drainage are emerging,After years of development,ERCP has become an important means of diagnosis and treatment of pancreaticobiliary diseases.However,both diagnostic ERCP and therapeutic ERCP are invasive technologies,and some complications are inevitable,some of them are even fatal.Post ERCP pancreatitis(PEP)and post ERCP Hyperamylasemia(PEH)is the disease with the highest incidence and the most concern.With the increasing number of patients with basic diseases and the difficulty of therapeutic ERCP,the incidence of PEP and PEH is still high.How to prevent its occurrence has become the focus of clinicians' attention.With the continuous progress of research,some drug prevention measures have achieved results,including indomethacin suppository and somatostatin,among which indomethacin suppository is recommended by many guidelines,and the recommendation level of somatostatin is weaker than that of indomethacin suppository.However,as a commonly used drug for the treatment of pancreatitis in clinic,somatostatin is also widely used in the prevention of PEP,and many RCT studies have proved to be effective,but at present,there are few studies on the efficacy comparison between the two,about somatostatin Its clinical effect needs further confirmation.The efficacy of the two drugs in preventing PEP and PEH was compared in order to provide reference for clinical practice.MethodFrom January 2019 to December 2019 in our hospital,the patients who met ERCP were randomly divided into two groups,indomethacin group and somatostatin group.In the indomethacin group,100 mg of indomethacin was given to the anus 30 minutes before operation,and in the somatostatingroup,250 ? g of somatostatin was given intravenously 30 minutes before operation,and after operation,250 ? g / h of somatostatin was pumped for 11 hours.Before and after the operation,each patient was evaluated whether there were relevant risk factors and operation related risk factors,and finally calculated the corresponding risk persons in each group The number of patients and the causes of ERCP in each group were calculated to see whether there was statistical difference.The observation indexes of clinical efficacy included the comparison of amylase value and liver function level between the two groups before and after operation,the incidence of PEP,the incidence of PEH,the proportion of clinical severity of PEP,the average length of stay and other related indexes.The calculation of whether there was statistical difference.All statistical analysis was performed using SPSS 24.0,measurement data was expressed by(? X±S),According to the normal distribution,the independent-sample t test is used,and the Mann-Whitney U test is used for the non-normal distribution independent sample t test was used,count data was expressed by %,X2 test was used,and P<0.05 was considered statistically significant.Results1.Baseline data,related risk factors and disease types 134 patients were included in this study,4 of them were withdrawn from the study due to the inability to intubate or tolerate the operation during the operation,and 130 patients were included in the final statistics,including 66 patients in indomethacin group and 64 patients in somatostatin group.There was no statistical difference between the two groups in the type of disease that caused the patient,as well as the patient related risk factors and operation related risk factors(P > 0.05).2.Blood amylase,liver function and average hospital stay There was no statistical difference between the two groups in terms of preoperative and postoperative liver function values and average hospital stay(P > 0.05).The preoperative amylase value of the two groups was(57.50 ± 18.29)U / L,(58.67 ± 18.58)U / L,no statistical difference(P > 0.05).The serum amylase values of indomethacin group at 6 hours and 24 hours after operation were respectively(314.29 ± 216.73)U / L,(178.29 ± 98.26)U / L,and that of somatostatin group was(227.45 ± 155.42)U / L,(111.79 ± 53.34)U / L.there was a statistical difference between the two groups(P=0.002,0.001).3.The number of people with PEP and PEH In this study,10(7.69%)people had PEP,including 6(9.09%)in indomethacin group and 4(6.25%)in somatostatin group,There was no significant difference in the number of PEP between the two groups(P > 0.05).In this study,16(12.31%)people had PEH,including 10(15.15%)in indomethacin group and 6(9.38%)in somatostatin group,There was no statistical difference in the number of patients(P > 0.05).Conclusion1.In the randomized controlled experiment of our center,the effect of perioperative micro pump injection of somatostatin on prevention of PEP and PEH is similar to that of preoperative anorectal application of indomethacin suppository.2.Compared with indomethacin suppository,pumping somatostatin during the perioperative period in our center can significantly reduce the blood amylase value after ERCP. |
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