ERCP引发急性胰腺炎的高危因素探讨

目的　探讨与ERCP(内镜下逆行胰胆管造影 )引发急性胰腺炎有关的高危因素。方法　对该院2 0 0 0年 1月～ 2 0 0 2年 12月行ERCP检查或治疗的 380例患者进行回顾性分析 ,用单变量分析相关的危险因素。结果　 17例于ERCP后发生急性胰腺炎 ( 4 .4 % ) ,380例中 2 80例为治疗性 ,15例并发急性胰腺炎( 4 .8% ) ,10 0例为诊断性 ,2例并发急性胰腺炎 ( 2 .0 % ) ,与ERCP引发急性胰腺炎相关的主要因素有 :内镜下括约肌切开 (EST) ,针状刀预切开乳头 ,多次乳头插管 ,胰管深插 ,多次胰管造影 ,导引钢丝辅助插管 (P <0 .0 5 ) ,高危人群为奥狄氏括约肌功能障碍者 ,有胰腺炎病史者。结论　治疗性ERCP较诊断性ERCP易并发急性胰腺炎 ,急性胰腺炎的发生主要与技术操作有关 ,娴熟的内镜技术 ,严格掌握指征可降低发生率。

Risk factors for acute pancreatitis induced by ERCP

Objective: To assess the risk factors for ERCP inducing pancreatitis. Methods: Three hundred and eighty patients who had been undergone ERCP were entered respectively, univariate analyses were used to identify risk factors for ERCP inducing pancreatitis.Results: Seventeen patients developed acute pancreatitis among 380 patients. There were 280 received therapeutic ERCP, 15 patients developed acute pancreatitis (4.8%) ,100 patients received diagnostic ERCP and 2 patients developed acute pancreatitis (2.0%) .Risk factors for post-ERCP pancreatitis were endoscopic sphincterotomy, precut access papillotomy by needle knife ,multiple cannulation attemps, pancreatic duct manipulation, multiple pancreatic injection, guidewire used to achieve cannulation. ( P <0.05) .Characteristics associated with an increased risk of pancreatitis were sphincter of Oddi dysfunction and recurrent pancreatitis. Conclusions:The frequency of acute pancreatitis in therapeutic ERCP was higher than that in diagnostics. Acute pancreatitis was related to operator' s skills during ERCP. With the improvement of ERCP skills and good controlling indications of ERCP, the frequency of ERCP-induced pancreatitis would decrease.