经内镜逆行胰胆管造影术后并发症的影响因素探讨

目的 探讨经内镜逆行胰胆管造影术(ERCP)后并发症的高危因素.方法 回顾性分析解放军总医院消化内镜中心2005年8月至2007年6月行ERCP诊断与治疗的全部住院患者的临床资料;统计并发症的发生情况,对数据进行单因素变量分析.结果 864例患者完成ERCP检查和治疗,ERCP操作成功率为96.8%(836/864).影响ERCP成功的主要因素有:肿瘤完全阻塞乳头致使导丝无法通过;肿瘤、溃疡或其他原因致肠腔狭窄使内镜不能进入十二指肠降部.出现并发症105例,发生率为12.2%,其中胰腺炎49例(5.7%),胆道感染37例(4.3%),上消化道出血15例(1.7%),穿孔4例(0.5%).经单变量分析显示,ERCP术后并发胰腺炎的相关因素主要有插管时间过长(>60 min,χ~2=5.22,P=0.022)、行胰管造影(χ~2=6.83,P=0.009)、奥迪括约肌功能障碍(χ~2=19.89,P=0.000)、血清胆红素正常(χ~2=4.02,P=0.045);ERCP术后并发胆道感染的相关因素主要有患有恶性胰胆系统肿瘤(χ~2=16.39,P=0.001)及胆道结石病史(χ~2=7.48,P=0.006)、胆道高位梗阻(χ~2=67.13,P=0.000)、胆管治疗性ERCP(χ~2=6.39,P=0.012).结论 ERCP术后并发症的发生与患者自身因素及医师操作技术有关,认识患者高危因素并提高医师操作水平是减少或避免ERCP术后并发症的关键.

Study on the risk factors of complications resulted from endoscopic retrograde cholangiopancreatography

Objective To study the risk factors of the complications of endoscopic retrograde cholangiopancreatography (ERCP). Methods Data were collected from patients who had undergone diagnostic and/or therapeutic ERCP during August 2005 and June 2007 in Gastro-enterologic Endoscopy Center of the Chinese PLA General Hospital. ERCP complications were recorded and analyzed by univariate analysis. Results The success rate of diagnostic and/or therapeutic ERCP were 96.8% (836/864) in 864 patients. The main factors which impeded a successful ERCP were: blockage of the duodenal papilla by tumors so that the guide wire could not pass through it, stenosis and obstruction of the bowel due to tumors, ulcer, or other lesions, and the endoscope could not be introduced into the descending part of duodenum. Complications occurred in 105 cases (12.2%), including post-ERCP panereatitis (PEP) in 49 cases (5.7%), cholangitis in 37 cases (4.3%), bleeding in 15 cases (1.7%) and perforation in 4 cases (0.5%). The univariate analysis showed that the main risk factors of PEP were lengthy cannulation time (longer than 60 minutes, χ~2=5.22, P=0.022), the pancreatic duet imaging (χ~2=6.83, P=0.009), sphincter of Oddi dysfunction (SOD, χ~2=19.89, P=0.000) and normal serum bilirubin (χ~2=4.02, P=0.045). The risk factors of acute eholangitis were malignancies (χ~2= 16.39, P=0.001), a history of bile duct calculus (χ~2=7.48, P=0.006), high bile duct obstruction (χ~2=67.13, P=0.000) and biliary tract therapeutic ERCP (χ~2=6.39, P=0.012). Conclusion The incidence of ERCP complications is related to the patients' intrinsic factors and the doctors' technical proficiency. An understanding of risk factors in patients and improve the skill of the operator are the key points to reduce or avoid critical complications after ERCP.