诊断与治疗性逆行胰胆管造影并发胰腺炎危险因素分析

目的：探讨诊断性胰、胆管显影与胆道支架、乳头括约肌切开取石术等治疗抗逆行胰、胆管造影（ERCP），对术后并发胰腺炎的影响。方法：412例ERCP操作分为7组，诊断性ERCP为胆胰双管显影（ERCP）组、单纯胆管显影（ERC）组组与单纯管显影（ERP）组，治疗组ERCP分为双管显影加支架术（ERCP＋支架）组、ERC＋支架组、ERCP＋乳头肌切开（EST）取石组及ERC＋EST取石组，比较各组术后4h、24h血清淀粉酶及临床症状改变。结果：术后4h、24h高淀粉酶血症发生率为17．7％及4．4％，并发急性胰腺炎的发生率为3．95，各组中以ERP组发病率为最高。结论：在ERCP操作中，反复胰管造影是并发术后胰腺炎主要危险因素，EST、支架治疗并不增加胰腺炎的发病率。

Risk factors for postoperative pancreatitis of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography

Objective To investigate the influence of endoscopic retrograde cholangiography (ERC), endoscopic retrograde pancreatography (ERP), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic biliary stenting on postoperative pancreatitis. Methods 412 patients referred to ERCP were divide into 7 groups, there were both biliary and pancreatic ducts group (ERCP), biliary duct contrast filling group (ERC), pancreatic duct contrast filling group (ERP), ERCP plus biliary stenting group (stent), ERC plus stent, ERCP plus EST and stone extraction (SE) group, and ERC plus EST and SE group. And the differences of postoperative serum amylase in 4 hours and in 24 hours as well as clinical symptoms were compared among different groups. Results The incidence of postoperative hyperamylasaemia in 4 hours and 24 hours were 17.7% and 4.4% respectively. The incidence of postoperative acute pancreatitis was 3.9%, and ERP group had the highest incidence of postoperative acute pancreatitis among the 7 groups. Conclusions Repeated pancreatic duct contrast filling during ERCP manipulation is the main risk factor for postoperative pancreatitis, and therapeutic ERCP such as EST, stent and SE does not increase the incidence of postoperative pancreatitis.