诊断性与治疗性ERCP早期并发症与处理

目的 探讨诊断性及治疗性ERCP早期并发症发生情况及处理。方法 回顾总结了我国23年间8579例次诊断性与治疗性ERCP临床资料。分析了早期并发症发生情况。种类、处理及预后。结果 23年间8579例ERCP诊疗中，共发生早期并发症112例（1.31%)，其中诊断性ERCP发生率为1.30%(95/7290)，治疗性ERCP为1.32%(17/1289)，并发水肿型胰腺炎38例（0.44%)，胆道感染30例（0.35%)，消化道大出血26例（0.30%)，药物反应8例（0.09%)，结石及取石篮嵌顿5例（0.06%)，肠穿孔3例（0.03%)，急性出血坏死型胰腺炎1例（0.01%)，后腹膜腔积气1例（0.01%）。112例并发症中，经内科保守治疗痊愈106例（94.6%)，外科手术治疗5例（4.5%(。1例死亡。结论 诊断性ERCP并发症中以急性胰腺炎发生率为高，可能与插管困难，反复显影，注射造影剂压力过大，量过多有关；治疗性ERCP并发症中以出血为常见，与操作技术，伴有黄疸及糖尿病等因素有关。绝大多数并发症可经内科保守治疗而得以痊愈，仅极少数患者需外科手术处理。

Early complications of diagnostic and therapeutic ERCP and its treatment

Objective To investigate the occurrence of early complications of diagnostic and therapeutic ERCP and its treatment .Methods Occurrence,kind,treatment and outcome of early complications of diagnostic and therapeutic ERCP were respectively reviewed in 8 579 cases in our hospital between January 1977 and December 1999.Results 112 cases had early complications(1.31%).In diagnostic ERCP morbidity of early complications was 1.30%(95/7290) and it was 1.32%(17/1289)in therapeutic ERCP.Of them,acute pancreatitis occurred in 38 cases(0.44%),billiary infection 30 cases(0.35%),bleeding of digestive tract 26 cases(0.30%),drug reaction 8 cases(0.09%),stone and basket incarceration 5 cases(0.06)%,intestinal perforation 1 cases (0.01%) and retroperitoneal pneumatosis 1 cases(0.01%).Of them,106 patients were cured by conservative therapy.Operations were performed in 5 patients.1 patient died.Conclusion In diagnostic ERCP acute pancreatitis is the most common complication,which may be related to difficulty of cannulation,repeated developing and inappropriately injecting contrast medium. In therapeutic ERPC bleeding of digestive tract is the most common complication ,which is related to the procedure ,jaundice and diabetes.Most of complications can be cured by conservative therapy,but a minority needs operation.