逆行胰胆管造影术后并发症的护理

总结我院2000年3月-2003年12月83例行内窥镜逆行胰胆管造影术后患者的护理体会。     

逆行胰胆管造影术并发急性胰腺炎1例

患者,男性,64岁,因右上腹疼痛1周,加重1 d入院.B超提示:胆囊切除术后,肝内外胆管扩张伴多个强光团.入院后给予抗感染对症治疗后,症状、体征均消失,肝功能恢复正常.     

经内镜逆行胰胆管造影术相关并发症81例临床分析

目的研究分析经内镜逆行胰胆管造影术后相关并发症发生的主要原因,以减少经内镜逆行胰胆管造影手术后出现的并发症。方法对2009年9月-2012年10月我院收治的经内镜逆行胰胆管造影手术的患者81例为临床研究对象,所有患者在手术后均出现了并发症,对患者的并发症类型等进行总结,分析导致并发症发生的主要原因,提出预防措施。结果 81例并发症中包括：胰腺炎39例,胆道感染21例,上消化道出血16例,穿孔5例,其中以胰腺炎的发生率最高,组间比较差异明显,P〈0.05,差异有统计学意义;所有患者均经过内科保守治疗后痊愈。结论经内镜逆行胰胆管造影手术后并发症主要以胰腺炎和胆道感染最为多见,导致并发症发生的原因较多,需要医师在工作中细致认真,积极预防并发症的出现。     

经内镜逆行胰胆管造影术相关并发症81例临床分析

目的研究分析经内镜逆行胰胆管造影术后相关并发症发生的主要原因,以减少经内镜逆行胰胆管造影手术后出现的并发症。方法对2009年9月-2012年10月我院收治的经内镜逆行胰胆管造影手术的患者81例为临床研究对象,所有患者在手术后均出现了并发症,对患者的并发症类型等进行总结,分析导致并发症发生的主要原因,提出预防措施。结果 81例并发症中包括:胰腺炎39例,胆道感染21例,上消化道出血16例,穿孔5例,其中以胰腺炎的发生率最高,组间比较差异明显,P<0.05,差异有统计学意义;所有患者均经过内科保守治疗后痊愈。结论经内镜逆行胰胆管造影手术后并发症主要以胰腺炎和胆道感染最为多见,导致并发症发生的原因较多,需要医师在工作中细致认真,积极预防并发症的出现。     

内镜逆行胰胆管造影术后高淀粉酶血症和胰腺炎的相关因素分析

目的:研究分析内镜逆行胰胆管造影(ERCP)术后高淀粉酶血症和急性胰腺炎的相关危险因素。方法:收集2009年1月至2012年8月期间我院行ERCP诊疗患者的临床资料,分析术后高淀粉酶血症和急性胰腺炎的发生与年轻(年龄<50岁)、女性、既往胰腺炎病史、插管困难、胰实质显影,粘膜脱下切除术(EST)操作等可能危险因素之间的关系。结果:A组患者年轻(<50岁)、女性患者比例、存在胰腺炎病史、插管困难及胰腺实质显影的比例均显著高于C组,其差异具有统计学意义(P<0.05)。与C组相比,B组患者年轻(<50岁)、女性患者比例、存在胰腺炎病史、胰腺实质显影及EST操作的比例更高,其差异具有统计学意义(P<0.05)。B组患者胰腺实质显影的比例显著高于A组,其差异具有统计学意义(P<0.05)。结论:ERCP术后并发高淀粉酶血症和胰腺炎的危险因素是多方面的,不仅要对具备相关危险因素的患者加强预防意识,而且要提高ERCP操作的技术水平和熟练程度,以最大程度降低ERCP操作对胰胆系统的损伤,发挥ERCP诊疗的微创优势。     

内窥镜逆行胰胆管造影术的应用

在 X线电视监视下行内窥镜逆行胰胆管造影 ,探讨内窥镜逆行胰胆管造影术的应用意义。结论内窥镜逆行胰胆管造影术对肝、胆、胰腺病变的诊断有较高的价值且无太大的危险性 ,值得推广应用     

浅议经内镜逆行胰胆管造影术并发症及预防

随着内镜设备的改进及内镜技术的提高,其在消化道疾病的诊断和治疗中发挥了重要作用,但经内镜逆行胰胆管造影术术后并发症的发生在一定程度上限制了该技术的广泛应用,其近期并发症主要为低氧血症和心脏意外、胰腺炎、穿孔、感染、出血等,远期并发症主要为结石复发、乳头狭窄、胆管炎、胆囊炎、复发性急性胰腺炎和(或)慢性胰腺炎、肝脓肿等。如何避免和减少并发症的发生、并发症发生后怎样采取积极措施和正确治疗仍然是临床研究的课题。     

内镜逆行胰胆管造影术在肝移植术后胆道并发症诊治中的应用

目的 评价内镜逆行胰胆管造影术（ERCP）在肝移植术后胆道并发症诊治中的有效性. 方法 回顾性总结10例因肝移植术后胆道并发症而行ERCP诊治的患者的临床资料. 结果 10例共行ERCP 13次（其中3例行6次检查）,发现胆漏2例,胆总管结石2例,十二指肠乳头肌功能失调1例,胆管吻合口狭窄5例（其中伴胆泥3例,胆管结石1例）.十二指肠乳头肌功能失调的诊断是基于供受胆管均扩张同时存在肝酶异常,且经十二指肠乳头肌切开术后肝酶恢复正常.内镜治疗包括十二指肠乳头肌切开术4例,探条扩张3例,气囊扩张2例;放置胆道支架5例.内镜治疗的成功率为92.31%（12/13）.所有病例均未出现严重并发症. 结论 ERCP对肝移植术后胆道并发症的诊断正确、治疗安全有效,可作为治疗胆道并发症首选的非手术方法.     

125例胆囊切除术后内窥镜逆行性胰胆管造影术检查结果分析

本文对 12 5例胆囊切除术后患者内窥镜逆行性胰胆管造影术 (ERCP)检查结果进行总结 ,分析造成胆囊切除术后综合征的原因 ,为进一步处理提供依据 ,现报告如下。1　临床资料本组 12 5例中 ,男 6 1例 ,女 6 4例 ,年龄 2 8～ 87岁 ,平均5 6 .7岁 ,行单纯胆囊切除 73例 ,胆囊切除 +胆总管探查 +T型管引流 5 2例 ,其中 4例同时行胆肠吻合术。主要临床表现为腹痛 4 2例 ,黄疸 17例 ,发热 6例 ,黄疸伴腹痛 2 3例 ,发热伴黄疸 7例 ,发热伴腹痛 10例 ,发热、黄疸、腹痛 13例 ,其他表现 7例。2　检查方法采用OlympusJF2 30型十二指肠镜。Olympus切…     

治疗性逆行胰胆管造影临床价值分析

目的：探讨治疗性内镜逆行胰胆管造影术（ERCP）的临床应用价值及其相关并发症．方法：对2005-01／2008-07有胰胆疾病的302例患者进行ERCP治疗．收集临床资料进行全面统计,回顾性分析．结果：患者以老年比例最人．302例ERCP治疗总成功率为84．4％,其中前150例成功率为79．3％,后152例成功率为89．5％．并发症共11例,总体并发症发生率为3．6％．并发症均经内科保守治疗及内镜下治疗治愈,无外科手术及死亡病例．结论：治疗性ERCP是一项安全、有效的治疗技术．适用于多种胆胰疾病．操作成功率与术者的经验积累有密切关系．其并发症多数是可预防的,内科保守治疗联合内镜下治疗可治愈绝大多数并发症．     

内镜下逆行胰胆管造影对肝移植术后胆道并发症的诊疗作用(附12例报告)

目的 评价内镜下逆行胰胆管造影(ERCP)对肝移植术后胆道并发症的诊断和治疗价值。方法 应用电子十二指肠镜对原位肝移植术后疑有胆道并发症(梗阻性黄疸)的12例患者进行ERCP。结果 显示胆总管狭窄(梗阻)9例(伴胆总管结石2例),胆总管结石2例(伴胆总管扩张1例),移植肝肝内胆管变细1例。内镜下作胆总管气囊扩张、取石、放置金属胆总管内支架1例,Oddi括约肌切开取石3例,留置鼻胆管引流2例。结论 ERCP可作为原位肝移植术后胆道并发症诊断和治疗的主要手段,而且对大多数肝移植术后病人是安全有效的。     

诊断性及治疗性内镜逆行胰胆管造影的应用价值(附7238例分析)

目的：探讨经内镜逆行胰胆管造影（ＥＲＣＰ）检查的方法学及临床应用价值。方法：１９７７年１月至１９９８年６月我科对疑有胰胆疾病的７２３８例患者进行ＥＲＣＰ检查，有适应证者同时进行内镜下取石，扩张，引流等治疗，对以上资料进行全国统计，分析ＥＲＣＰ检查的临床价值及并发症。结果：７２３８例患者行ＥＲＣＰ检查共计７５７９例次，总成功率为９４．８％，胰管显影率为７５．７％，胆管显影率为８７．１％，发现胆管疾病     

环泊酚在无痛内镜逆行胰胆管造影术中的应用效果研究

目的探究不同剂量环泊酚复合舒芬太尼在无痛内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)中的应用效果。 方法选取因胆总管结石拟行无痛ERCP的患者150例,采用随机数字表法将患者随机分为3组,分别为C组50例、R1组50例、R2组50例。C组采用0.1 μg舒芬太尼联合2 mg/kg丙泊酚诱导,6 mg/(kg·h)丙泊酚术中维持方案;R1组采用0.1 μg/kg舒芬太尼联合0.4 mg/kg环泊酚诱导,1 mg/(kg·h)环泊酚术中维持方案;R2组采用0.1 μg/kg舒芬太尼联合0.5 mg/kg环泊酚诱导,1.5 mg/(kg·h)环泊酚术中维持方案。比较3组镇静成功率、不良事件发生率、血流动力学等指标。结果3组患者麻醉诱导后即刻MOAA/S评分、诱导完成30 s后MOAA/S评分、呛咳发生率、苏醒时间差异无统计学意义（P>0.05）;与C组比较,R1组、R2组体动发生率与镇静成功率差异无统计学意义（P>0.05）;与R1组比较,R2组的体动发生率更低,镇静成功率更高。3组患者心动过缓、呃逆、术后恶心的发生率差异无统计学意义（P>0.05）;与C组比较,R1组低血压发生率更低（P<0.05）,R1组、R2组呼吸抑制发生例数更少（P<0.05）,R1组、R2组注射痛更少（P<0.05）。3组患者各时间段心率变化无统计学意义（P>0.05）;3组患者进入检查室时、转入苏醒室时平均动脉压差异无统计学意义（P>0.05）;与C组相比,麻醉诱导后R1组、R2组平均动脉压更高（P<0.05）,十二指肠乳头插管后R1组平均动脉压更高（P<0.05）,手术结束时R1组平均动脉压更高（P<0.05）;与R1组相比,R2组十二指肠乳头插管后平均动脉压较低（P<0.05）。 结论以0.1 μg/kg舒芬太尼联合0.5 mg/kg环泊酚诱导及1.5 mg/(kg·h)环泊酚术中维持方案在无痛ERCP中应用效果较好,兼具了镇静成功率高及不良事件发生率低的优点。     

Preventive effect of ulinastatin and gabexate mesylate on post-endoscopic retrograde cholangiopancreatography pancreatitis

Background Post-endoscopic retrograde cholangiopancreatography pancreatitis （PEP） is regarded as one of the worrisome complications of endoscopic retrograde cholangiopancreatography （ERCP）. Results of randomized controlled trials evaluating the preventive effect of ulinastatin and gabexate mesylate （GM） on PEP are contradictory. The present study was designed to evaluate the prophylactic effect of ulinastatin and GM on PEP with meta-analyses of randomized controlled trials （RCTs）. Methods Five electronic databases were searched for RCTs evaluating the preventive effect of ulinastatin and GM on PEP. Summary effects were assessed with the methods recommended by the Cochrane Collaboration. Results Twelve studies involving 5105 participants were included in our meta-analyses. Administration of ulinastatin decreased the incidence of PEP only at sufficient doses （OR, 0.39; 95% C/, 0.19 to 0.81; P=0.01）. Number needed to treat （NNT） was 6. And administration of ulinastatin also reduced the incidence of post-ERCP hyperamylasemia （PEHA） （OR, 0.40; 95% C/, 0.28 to 0.58; P〈0.000 01）. Slow infusion of high-dose GM was effective for PEP prevention （OR, 0.44; 95% Cl, 0.25 to 0.79; P=0.006）, and rapid infusion of low-dose GM also showed efficacy for PEP prophylaxis （OR, 0.37; 95% C/, 0.20 to 0.69; P=0.002）. NNT was 7 and 6 respectively. However, administration of GM at low doses and by slow infusions was ineffective （OR, 0.99; 95% Cl, 0.64 to 1.55; P=0.98）. Administration of GM had the tendency to reduce PEHA rate, but not to a statistical significance （OR, 0.86; 95% CI, 0.73 to 1.01; P=0.06）. When low-quality studies were excluded, the meta-analysis with two high-quality studies indicated that ulinastatin did not reduce the rate of PEP （OR, 0.63; 95% Cl, 0.32 to 1.26; P=0.19） and PEHA incidence （OR, 0.80; 95% Cl, 0.31 to 2.07; P=0.64）. The meta-analysis with six high-quality studies showed that GM administration decreased PEP incidence （OR, 0.52; 95% CI, 0.29 to 0.91; P=-0,02）, while was not efficacious for PEHA prevention （OR, 0.88; 95% C/, 0.74 to 1.04; P=0.12）. Conclusions Ulinastatin and GM may be of value for the prophylaxis of PEP. GM should be administered at high doses and by rapid infusions. And the doses of ulinastatin should be sufficient. However, the conclusions are not overwhelming. More large-sample size and high-quality RCTs are still needed to elucidate whether administrations of the two drugs really have prophylactic effect on PEP.     

Application of endoscopic retrograde cholangiopancreatography in the diagnosis and treatment of pancreaticobiliary disease

Pancreaticobiliarydiseaseiscommonineasterncountries.Clinicaldiagnosisis"lainlybasedonimagingfindings.Endoscopicretrogradecholangiopancreatography(ERCP)playsanimportantroleindiagnosingthediseases,especiallyinthediagnosisanddifferenciatlonofpancreticobiliarylithiasls,pancreaticobiliarymalignanttumorandchronicpancreaticdisease.SinceendoscopicpapillotomywasintroducedInthemiddleof1970s,physicianshavebeenabletomakeartincisionattheduodenalpapilla,andremovebileductstoneswithendoscope,avoidinglaproto…     

50例梗阻性黄疸患者内窥镜逆行胰胆管造影分析

目的 探讨内窥镜逆行胰胆管造影(ERCP)对梗阻性黄疸的临床诊断价值.方法 回顾性分析经手术或病理诊断证实的50例梗阻性黄疸患者的临床资料和ERCP表现.结果 恶性梗阻性黄疸ERCP多表现为胆管梗阻端呈偏心结节状充盈缺损或呈截断状,边缘不光整,管壁僵硬,其上方胆管呈"软藤征"表现;良性梗阻性黄疸ERCP多表现为胆管梗阻端呈杯口状,管壁柔软,其上方胆管扩张呈"软藤征"表现.结论 ERCP对梗阻性黄疸有一定的诊断价值,它能显示梗阻的程度、阻塞的部位及病因,对指导临床治疗及术后评估能提供可靠的依据.     

Application of endoscopic retrograde cholangiopancreatography in biliary-pancreatic diseases

Background Endoscopic retrograde cholangiopancreatography （ERCP） has been used increasingly for the treatment of choledocholithiasis, gallstone pancreatitis, and benign or malignant bile duct or pancreatic duct stenosis. The purpose of this study was to evaluate ERCP for the diagnosis and therapy of biliary-pancreatic diseases. Methods A total of 2075 patients who underwent diagnostic and therapeutic ERCP from June 2001 to March 2009 were analyzed retrospectively. Achievement and complication rates were calculated, and the therapeutic effect was observed. Results In all the 64 cases who underwent diagnostic ERCP, the procedure was successful, in 2011 cases therapeutic ERCP was performed, and the success rate was 94.6%. In the therapeutic ERCP cases, 1434 （93.0%） were successful among the 1542 cases of choledocholithiasis, and 422 （90.0%） of the 469 cases with benign or malignant bile duct or pancreatic duct stenosis, or acute obstructive suppurative cholangitis with stent placement or endoscopic nasobiliary drainage were successful. Fifty-nine （90.8%） cases of the 65 who underwent a pre-cut for pancreatic sphincterotomy were successful. Complication rate was 5.1% and the most frequent complication was acute pancreatitis （4.4%）. Conclusions ERCP is one of the major diagnostic and therapeutic methods for biliary-pancreatic disease. Therapeutic ERCP is a minimally invasive, safe and effective treatment method for various biliary-pancreatic diseases.     

胰管支架预防高危患者逆行胰胆管造影术后胰腺炎

目的 探讨胰管支架置入在预防高危患者经内镜逆行胰胆管造影（ERCP）术后胰腺炎（PEP）及高淀粉酶血症中的作用。方法 回顾性分析2013年1月至2014年12月间我院行ERCP治疗的160例PEP高危患者的临床资料。依据是否置入胰管支架,将其分为胰管支架组82例（放置支架）和对照组78例（未放置支架）。观察术后患者腹痛情况,监测术后3h、24h血清淀粉酶水平, 比较两组术后胰腺炎、高淀粉酶血症的发生率。结果 胰管支架组术后腹痛发生率、腹痛评分[19.5% （16/82）、(1.24±0.58)]均低于对照组[43.6%（34/78）、(1.68±0.97)],差异有统计学意义（P=0.001）。胰管支架组术后3h和术后24h血清淀粉酶分别为（184.89±257.33）U/L和（268.07±344.73）U/L,均低于对照组（305.35±371.81）U/L和（465.86±639.94）U/L,差异有统计学意义（P<0.05）。胰管支架组急性胰腺炎、高淀粉酶血症发生率[2.4%（2/82）、17.1%(14/82)]显低于对照组[11.5%(9/78)、30.8%(24/78)],差异有统计学意义（P<0.05）。结论 胰管支架置入可有效预防高危患者ERCP术后胰腺炎及高淀粉酶血症的发生。     

乌司他丁和加贝酯预防ERCP术后胰腺炎的荟萃分析

Abstract Background and aim: Post endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is regarded as one of the worrisome complications of endoscopic retrograde cholangiopancreatography (ERCP). Results of randomized controlled trials evaluating the preventive effect of ulinastatin and gabexate mesylate on PEP are contradictory. The present study is designed to evaluate the preventive effect of ulinastatin and gabexate mesylate on PEP with a meta-analysis of randomized controlled trials. Methods: Five electronic databases were searched for randomized controlled trials evaluating the preventive effect of ulinastatin and gabexate mesylate on PEP. Effects were summarized with the methods recommended by the Cochrane Collaboration. Results: Twelve studies including 5105 participants were included in this meta-analysis. Administration of ulinastatin decreased the incidence of PEP, but only at sufficient doses (OR, 0.39; 95%CI, 0.19 to 0.81; P=0.01). Number needed to treat (NNT) was 6. And administration of ulinastatin also reduced the incidence of post ERCP hyperamylasemia (OR, 0.40; 95%CI, 0.28 to 0.58; P<0.00001). Gabexate mesylate was effective in the prevention of PEP when administered at high doses and as slow infusions (OR, 0.44; 95%CI, 0.25 to 0.79; P=0.006) or at low doses and as rapid infusions (OR, 0.37; 95%CI, 0.20 to 0.69; P=0.002). NNT was 7 and 6 respectively. However, administration of gabexate mesylate at low doses and as slow infusions was ineffective (OR, 0.99; 95%CI, 0.64 to 1.55; P=0.98). Administration of gabexate mesylate had the tendency to reduce post ERCP hyperamylasemia rate, but not to a statistical significance (OR, 0.86; 95%CI, 0.73 to 1.01; P=0.06). Conclusion: Ulinastatin and gabexate mesylate are recommended to be used for the prophylaxis of PEP. However, gabexate mesylate should be administered at high doses and as rapid infusions. And the doses of ulinastatin should be sufficient.