胆管不均匀扩张与ERCP术后胰腺炎的关系

  目的  探讨胆管不均匀扩张与ERCP术后胰腺炎的关系。  方法  选择昆明医科大学第二附属医院2018年1月到2021年12月共247例因胆总管结石行内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography ，ERCP） + 内镜下乳头括约肌切开术（endoscopic sphincterotomy，EST）+内镜下鼻胆管引流术（endoscopic nasobiliary drainage，ENBD）的患者，分扩张组（胆管直径≥10 mm）（A组 = 84）与无扩张组（胆管直径 < 10 mm）（B组 = 163，对照组）进行统计学处理并比较。  结果  A组84例，其中女性45例；可疑的Oddi括约肌功能障碍（sphincter of oddi dysfunction ，SOD）患者9例；困难插管者30例，其中插到胰管者22例，胰管显影者8例；胆胰管汇合异常（anomalous pancreaticobiliary ductal junction ，APBDJ）者9例。A组患者中ERCP术后发生轻度胰腺炎10例，中度胰腺炎8例，重度胰腺炎3例。B组163例，其中女性72例；可疑的SOD患者11例；困难插管者63例，其中插到胰管者61例，胰管显影者2例；APBDJ患者1例。B组患者中ERCP术后发生轻度胰腺炎10例，中度胰腺炎1例，重度胰腺炎者4例。A组行吲哚美辛肛栓患者数为30例，B组为57例。A组ERCP术后胰腺炎（post-ERCP pancreatitis，PEP）发生率为25%，B组PEP发生率为9.20%，两者比较差异具有统计学意义（P = 0.001）；将247例患者整体进行Logistic单因素回归分析显示，胆管扩张（OR = 3.289，95%CI = 1.593～6.792，P = 0.001）是PEP的独立危险因素。  结论  女性患者且伴有胆管不均匀扩张患者（胆管直径≥10 mm）比无扩张患者（胆管直径 < 10 mm）在ERCP术后更容易患PEP。因此，在对这部分患者行ERCP+EST+ENBD手术时需谨慎处理，尽量避免行内镜下复杂的手术操作。

Relationship between Bile Duct Uneven Dilation and Postoperative Pancreatitis after ERCP

  Objective   To investigate the relationship between bile duct uneven dilatation and postoperative pancreatitis after ERCP.   Methods   A total of 247 cases of ERCP+EST + ENBD due to bile duct stone were performed in the Second Affiliated Hospital of Kunming Medical University from January 2018 to December 2021. They were divided into the bile duct dilation group （bile duct diameter ≥10 mm） （group A = 84） and the nondilated group （bile duct diameter < 10 mm） （group B = 163） as control group for statistical processing and comparison.   Results   There were 84 patients in group A, including 45 females; 9 cases of suspected SOD; there are 30 patients with difficult cannulation, including 22 patients with pancreatic guidewire passages and 8 patients with development of the pancreatic duct; 9 cases of APBDJ.In group A, there were 10 cases of mild pancreatitis, 8 cases of moderate pancreatitis, and 3 cases of severe pancreatitis. There were 163 patients in group B, including 72 females; 11 cases of suspected SOD; there were 63 patients with difficult cannulation, including 61 pancreatic guidewire passages and 2 patients with development of the pancreatic duct; 1 case of APBDJ. In group B, there are 10 cases of mild pancreatitis, 1 case of moderate pancreastitis, and 4 cases of severe pancreatitis. There were 30 patients in group A and 57 patients in group B who received indomethacin anal embolus. The incidence of PEP was 25% in group A and 9.2% in group B, and the difference between the two groups was statistically significant （P = 0.001）. Logistic univariate regression analysis of 247 patients showed that bile duct dilatation （OR = 3.289, 95%CI = 1.593～6.792, P = 0.001） was an independent risk factor for PEP.   Conclusions  Female patient with uneven bile duct dilation （bile duct diameter ≥10 mm） is more likely to develop PEP than nondilated patient （bile duct diameter < 10 mm）. Therefore, ERCP + EST + ENBD should be carefully handled in these patients, and complex endoscopic surgical operations should be avoided as far as possible.