發(fā)布時間：2018-06-17 07:33

  本文選題：內(nèi)鏡逆行胰膽管造影術(shù) + 急性胰腺炎��； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：背景:內(nèi)鏡技術(shù)是醫(yī)學(xué)發(fā)展最為迅速的技術(shù)之一,近年來隨著內(nèi)鏡器械及技術(shù)的日益發(fā)展,ERCP及其相關(guān)技術(shù)已廣泛應(yīng)用于膽胰疾病的診療,其具有療效好、創(chuàng)傷小、并發(fā)癥少、明顯改善患者預(yù)后等優(yōu)勢;但是作為一種侵入性的有創(chuàng)操作,它同時會產(chǎn)生許多的并發(fā)癥,其中胰腺炎是其最常見、最嚴重的并發(fā)癥,這在某種程度上可能限制了該技術(shù)的廣泛應(yīng)用與發(fā)展;因此,如何降低ERCP術(shù)后胰腺炎的發(fā)生率、減輕其嚴重程度至關(guān)重要。目的:通過綜述目前ERCP術(shù)后胰腺炎預(yù)防策略的研究現(xiàn)狀,總結(jié)預(yù)防ERCP術(shù)后胰腺炎的可行方案,為其在臨床實踐中安全、高效的應(yīng)用提供一定的參考。方法:以“內(nèi)鏡逆行胰膽管造影術(shù)、急性胰腺炎、ERCP術(shù)后胰腺炎、預(yù)防、并發(fā)癥”等檢索詞進行檢索,找出預(yù)防ERCP術(shù)后胰腺炎相關(guān)的研究。結(jié)果與結(jié)論:對于ERCP術(shù)后胰腺炎的預(yù)防首先應(yīng)當(dāng)嚴格的篩選病人,掌握其適應(yīng)癥,避免行診斷性ERCP,對于疑似膽總管結(jié)石的患者可行EUS/MRCP等更加安全有效的方法代替;其次評估患者相關(guān)危險因素,并適當(dāng)?shù)闹蹦c給予非甾體消炎藥;技術(shù)層面上可以使用導(dǎo)絲引導(dǎo)插管,盡量減少插管的次數(shù),避免注射造影劑或者直接損傷胰管,同時臨時放置胰管支架等也可減少ERCP術(shù)后胰腺炎的發(fā)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.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R576

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