经内镜逆行胰胆管造影术后并发胰腺炎危险因素分析  

Risk factors of post endoscopic retrograde cholangiopancreatography complicated pancreatitis

作　　者：黄继征[1] 霞明[1] 龚传明[1] 程建国[1] 文峰[1] 

机构地区：[1]解放军第161中心医院消化内科,湖北武汉430010

出　　处：《局解手术学杂志》2011年第2期174-176,共3页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨经内镜逆行胰胆管造影术(ERCP)后并发胰腺炎(PEP)的危险因素,为PEP的预防提供参考。方法回顾性分析1 896例ERCP患者,分为PEP组(n=285)及无PEP组(n=1 161),对比分析两组各相关危险因素,涉及患者因素、操作因素及术者因素。结果患者因素中女性、年龄(小于60岁)、胰腺炎病史、无胆总管结石、疑有Odd i括约肌功能障碍者易并发PEP(P<0.05);而有无胆红素增高、胆总管直径过小(小于0.4 cm)、有无壶腹部憩室、合并糖尿病、高血压与PEP的发生无显著相关性(P>0.05)。操作因素中胰腺显影、胰管括约肌切开术、胆道括约肌气囊扩张术患者在PEP组所占比例明显高于无PEP组(P<0.05);而治疗性或诊断性ERCP、Odd i括约肌测压术、胆道括约肌切开术患者在两组中所占比例无显著差异。术者操作例数少、操作时间长、插管困难或失败与PEP的发生相关(P<0.05);而ERCP操作失败与PEP无关(P>0.05)。结论年龄小于60岁的女性,且有胰腺炎病史和疑有Odd i括约肌功能障碍、胰腺显影差、术者熟练性差、插管困难等是PEP的主要危险因素。Objective To explore the risk factors of post endoscopic retrograde cholangiopancreatography（ERCP） complicated pancreatitis（PEP） and to provide references to its prevention.Methods Totally 1 896 patients who underwent ERCP were divided into PEP group（n=285） and non-PEP group（n=1 161）.The risk factors of patients,operation and operator were analyzed.Results In patient factors,female,age（less than 60）,pancreatitis history,without choledocholithiasis,suspected Oddi＇s sphincter dysfunction were the risk factors for PEP（P〈0.05）,but bilirubin increase,common bile duct diameter（less than 0.4cm）,ampulla diverticulum,complicated diabetes or hypertension were not related with PEP（P〉0.05）.In operation factors,pancreas imaging,pancreatic duct sphincterotomy,aerocyst dilatation of bililary sphincter muscle were related with PEP（P〈0.05）,but the remedial or diagnostic ERCP,Oddi＇s sphincterometry,bile duct sphincterotomy were not related with PEP.For operators,fewer operation cases,prolonged operation time and difficult intubation were related with PEP（P〈0.05）,but ERCP operation defeat was not the risk factor for PEP（P〉0.05）.Conclusion Female,aged under 60,pancreatitis history,suspected Oddi＇s sphincter dysfunction,poor pancreas imaging and operator＇s skill as well as difficult intubation were the main risk factors for PEP.

关 键 词：经内镜逆行胰胆管造影术 胰腺炎 危险因素 

分 类 号：R657.51[医药卫生—外科学] R816.5[医药卫生—临床医学]