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中华介入放射学电子杂志 ›› 2021, Vol. 09 ›› Issue (03) : 294 -299. doi: 10.3877/cma.j.issn.2095-5782.2021.03.010

非血管介入

直肠应用吲哚美辛栓对于经皮胆道支架植入术后高淀粉酶血症和胰腺炎的预防作用:一项倾向性匹配分析研究
许晨1, 杨魏1, 任健吾1, 周卫忠1, 刘圣1, 施海彬1,()   
  1. 1. 210029 江苏南京,南京医科大学第一附属医院介入放射科
  • 收稿日期:2021-02-19 出版日期:2021-08-25
  • 通信作者: 施海彬

Rectal indometacin to prevent hyperamylasemia and pancreatitis following percutaneous biliary stent insertion: a study on propensity matching analysis

Chen Xu1, Wei Yang1, Jianwu Ren1, Weizhong Zhou1, Sheng Liu1, Haibin Shi1,()   

  1. 1. Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Nanjing 210029, China
  • Received:2021-02-19 Published:2021-08-25
  • Corresponding author: Haibin Shi
引用本文:

许晨, 杨魏, 任健吾, 周卫忠, 刘圣, 施海彬. 直肠应用吲哚美辛栓对于经皮胆道支架植入术后高淀粉酶血症和胰腺炎的预防作用:一项倾向性匹配分析研究[J/OL]. 中华介入放射学电子杂志, 2021, 09(03): 294-299.

Chen Xu, Wei Yang, Jianwu Ren, Weizhong Zhou, Sheng Liu, Haibin Shi. Rectal indometacin to prevent hyperamylasemia and pancreatitis following percutaneous biliary stent insertion: a study on propensity matching analysis[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(03): 294-299.

目的

探究术前直肠应用吲哚美辛栓对于经皮胆道支架植入(PTBS)术后高淀粉酶血症和胰腺炎的预防价值。

方法

回顾性收集2019年6月至2021年1月于我科收治且接受PTBS治疗的141例恶性胆道梗阻患者的临床资料,其中预防性使用吲哚美辛栓组29例,未用药组112例。两组患者按1∶4比例进行倾向性匹配分析,比较术后3 h和24 h的血淀粉酶水平以及高淀粉酶血症和胰腺炎的发生率,并记录其他并发症情况。

结果

实际匹配完成共110例,其中吲哚美辛组22例,未用药组88例,匹配后两组基线资料具有可比性。两组术后3 h及24 h的血淀粉酶水平分别为45.4(34.6,61.1) vs 60.6 (43.2,104.1) U/L和43.3 (34.5,61.8) vs 59.3 (44.2,76.4) U/L,组间差异具有统计学意义(P = 0.007,P = 0.026)。此外,吲哚美辛组术后胰腺炎的发生率为4.5%,低于未用药组的13.6%,但未见明显统计学差异(P = 0.417)。两组术后高淀粉酶血症的发生率相似(9.1%,11.4%)。所有患者均没有发生吲哚美辛相关的不良反应。

结论

术前直肠应用吲哚美辛栓能有效降低PTBS术后患者的血淀粉酶水平且相对安全,值得进一步临床研究。

Objective

To explore the effect of preoperative rectal indometacin on preventing hyperamylasemia and pancreatitis following percutaneous biliary stent insertion (PTBS).

Methods

During the period from June 2019 to January 2021, the clinical data of 141 patients with malignant biliary obstruction underwent PTBS in our department were collected. Among them, 29 patients were treated with indometacin rectally and the other 112 patients were included without indometacin. A propensity matching analysis was carried out according to the proportion of 1:4 in the two groups. The levels of serum amylase at 3 h and24 h after the procedure, and the incidence of hyperamylasemia and pancreatitis were compared. The other complications were recorded.

Results

In the present study, a total of 110 patients were matched, including 22 patients in the indometacin group and 88 patients in the untreated group. The baseline data of thetwo groups were comparable. The levels of serum amylase at 3h and 24h after the procedure in the two groups were 45.4 (34.6, 61.1) vs 60.6 (43.2, 104.1) U/L and 43.3 (34.5, 61.8) vs 59.3 (44.2, 76.4) U/L respectively, and the difference between the two groups was statistically significant (P = 0.007, P = 0.026). In addition, the incidence of pancreatitis in the indometacin group (4.5%) was lower than that in the untreated group (13.6%), however, there was no significant statistical difference (P = 0.417). The incidence of postoperative hyperamylasemia was similar between the two groups (9.1%, 11.4%). No indometacin related complications occurred.

Conclusions

Preoperative rectal indometacin can effectively reduce the level of serum amylase in patients following PTBS and is relatively safe, which is worthy of the further clinical study.

图1 流程
表1 患者匹配分析前后的基线特征
临床因素 匹配前 匹配后
吲哚美辛组(n = 29) 非用药组(n = 112) t / Z / χ2 P 吲哚美辛组(n = 22) 非用药组(n = 88) t / Z / χ2 P
年龄(岁) 68.4 ± 12.4 65.9 ± 10.9 1.073 0.285 67.8 ± 13.4 64.8 ± 10.9 1.107 0.271
性别     0.834 0.361     1.311 0.252
  17 55     13 40    
  12 57     9 48    
肿瘤类型     1.028 0.311     0.382 0.537
  胰腺癌 7 18     5 15    
  非胰腺癌 22 94     17 73    
梗阻部位     1.124 0.570        
  肝门部或胆总管上段 12 57     10 42    
  胆总管中下段 14 48     10 40    
  多段累及 3 7     2 6    
术前实验室指标                
  AMS (U/L) 35.2(30.4,50.7) 32.1(30.0,41.6) -1.376 0.169 36.0(50.3,30.5) 32.1(30.0,41.5) -1.366 0.172
  ALT (U/L) 180.1(308.2,71.8) 156.0(89.5,294.6) -0.286 0.775 191.7(326.8,107.6) 153.1(80.1,297.9) -0.859 0.390
  TBIL (μmol/L) 59.5(29.9,96.7) 63.4(37.6,110.3) -0.908 0.364 72.2(40.9,112.6) 60.3(41.1,110.4) -0.123 0.902
  WBC (109/L) 5.7(4.9,7.2) 6.9(4.8,9.3) -1.688 0.091 5.9(4.8,7.5) 6.4(4.7,9.2) -0.781 0.435
支架数量     1.666 0.435     1.141 0.565
  1 22 75     16 58    
  2 5 32     4 25    
  ≥ 3 2 5     2 5    
外引流管植入     0.123 0.726     < 0.001 > 0.999
  4 21     4 15    
  25 91     18 73    
碘粒子条植入     9.655 0.002     0.795 0.373
  9 10     2 2    
  20 102     20 86    
胰管显影     0.070 0.792     < 0.001 > 0.999
  2 12     2 10    
  27 100     20 78    
支架跨十二指肠乳头     0.247 0.619     0.229 0.632
  16 56     11 49    
  13 56     11 39    
表2 两组术后血清淀粉酶水平的比较(U/L)
表3 两组术后高淀粉酶血症及胰腺炎发生率的比较(%)
表4 两组术后并发症(%)
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