良性胆系疾病逆行胆胰管造影术后胰腺炎的危险因素分析  

Risk factors for post-post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with benign biliary diseases

作　　者：孙海[1] 张丰深[1] 邓小明[1] 杨琳[1] 杨星[1] 

机构地区：[1]解放军第324医院肝胆外科,重庆400020

出　　处：《第三军医大学学报》2010年第8期833-835,共3页Journal of Third Military Medical University

摘　　要：目的探讨良性胆系疾病逆行胆胰管造影(endoscopic retrograde cholangiopancreatography,ERCP)诊疗术后胰腺炎的危险因素。方法采用SPSS 11.0统计软件对169例良性胆系疾病ERCP诊疗患者从临床病理和技术操作分析ERCP术后胰腺炎(post-ERCP pancreatitis,PEP)的危险因素。结果169例患者出现11例PEP,发生率6.5%;43例诊断性ERCP中PEP 3例,发生率7.0%;126例治疗性ERCP中PEP 8例,发生率6.3%,两组PEP发生率比较无统计学差异(P>0.05)。单因素分析胆总管直径<10 mm、Oddis括约肌运动功能障碍(sphincter of Oddis dysfunction,SOD)、多次胰管插管差异有统计学意义(P<0.05);鼻胆管引流对PEP有预防作用(P<0.05)。Logistic回归分析提示SOD、多次胰管插管是PEP的危险因素(OR值分别为7.227、20.100);鼻胆管引流是PEP的保护因素(OR值为0.192)。结论SOD患者是PEP的危险人群,胆总管直径正常患者也应警惕,多次胰管插管是PEP的危险因素。鼻胆管引流和避免不必要的胰管插管是预防PEP的有效措施。Objective To explore the risk factors for post-endoscopic retrograde cholangiopancreatography（ERCP） pancreatitis in patients with benign biliary diseases.Methods Totally consecutive 169 patients with benign biliary diseases in our department during April 2007 to August 2009 were retrospectively analyzed.The risk factors for post-ERCP pancreatitis in them were analyzed in clinical pathology and ERCP operation-related aspects by SPSS11.0.Results There were 11（6.5%） post-ERCP pancreatitic patients in 169 patients after ERCP.There were 3（7.0%） patients who developed post-ERCP pancreatitis in 43 diagnostic ERCP patients and 8（6.3%） in 126 therapeutic ERCP.The incidence of post-ERCP pancreatitis has no significant difference between above 2 groups（P〉0.05）.By univariate analysis,the diameter of common bile duct less than 10 mm and sphincter of Oddis dysfunction（SOD） and mutiple cannulation of the pancreatic duct were all statistically different（P〈0.05）.Nasobiliary drainage was statistically different for preventing post-ERCP pancreatitis（P〈0.05）.In the Logistic regression,the risk factors with adjusted odds ratios（OR） were： SOD（OR=7.227）,mutiple cannulation of the pancreatic duct（OR=20.100）,the protective factor with OR was nasobiliary drainage（OR=0.192）.Conclusion Patients with SOD and mutiple cannulation of the pancreatic duct are risk factor for post-ERCP pancreatitis.Normal common bile duct should be cautioned.To prevent post-ERCP pancreatitis,unnecessary cannulation of pancreatic duct should be avoided and endoscopic nasobiliary drainage is the effective treatment.

关 键 词：逆行胆胰管造影 胰腺炎 鼻胆管引流 

分 类 号：R181.23[医药卫生—流行病学] R576.02[医药卫生—公共卫生与预防医学]