影响经内镜逆行胰胆管造影术手把手培训学员插管成功率的危险因素分析  

Risk factors influencing cannulation success rate of hands-on training of endoscopic retrograde cholangiopancreatography

作　　者：郑立跃[1] 潘阳林[1] 罗辉[1] 郭学刚[1] Zheng Liyue Pan Yanglin Luo Hui Guo Xuegang(Department of Gastroenterology, Xijing Hospital, The Fourth Military Medical University, Xi＇an 710032, China)

机构地区：[1]第四军医大学西京医院消化内科,西安710032

出　　处：《中华消化内镜杂志》2017年第4期269-273,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨影响ERCP手把手培训中学员插管成功率的危险因素，旨在提高ERCP的培训水平。方法回顾性分析2012年12月至2014年12月学员在西京消化病医院进行ERCP手把手培训的1193例病例资料，并对可能影响插管成功率的相关因素进行多因素Logistic回归分析。结果纳入患者选择性胆管插管1165例，胰管插管28例。学员选择性胆管插管成功率为58．5％（681／1165），教员接手后总体成功率为97．9％（1140／1165）；学员选择性胰管插管成功率为39．3％（11／28），教员接手后总体成功率为89．3％（25／28）。ERCP术后总体并发症发生率8．0％（96／1193），术后胰腺炎（PEP）发生率4．4％（53／1193）。多因素Logistic回归分析显示，胆管恶性狭窄（OR=0．44，95％CI：0．28—0．67，P〈0．01）、胆管良性或不明原因狭窄（OR=0．32，95％CI：0．17—0．60，P〈0．01）、怀疑乳头括约肌功能障碍（SOD）（OR=0．28，95％CI：0．16～0．47，P〈0．01）、合并有高血压（OR=0．65，95％CI：0．44～0．96，P〈0．05）、红细胞体积分布宽度（RDW）≥48fL（OR=0．69，95％CI：0．51～0．92，P〈0．05）、血小板（PLT）〈100×109／L（OR=1．68，95％CI：1．05—2．71，p〈0．05）为插管失败的独立危险因素。结论胆管良恶性或不明原因狭窄、怀疑SOD、合并有高血压、RDW和PLT异常是影响ERCP手把手培训学员插管成功率的危险因素。Objective To investigate risk factors decreasing cannulation success rate of trainees receiving hands-on ERCP training and to improve the level of ERCP training. Methods Clinical data of 1 193 ERCP cases involved in training in Xijing Hospital of Digestive Disease from December 2012 to December 2014 were retrospectively analyzed. Multivariate logistic regression analysis was performed to investigate the risk factors influencing cannulation success rate of trainees. Results There were 1165 and 28 patients undergoing common biliary duct （CBD）cannulation and pancreatic duct（PD） cannulation respectively. The success rate of CBD cannulation by trainees was 58.5%（681/1165） and the overall success rate was 97. 9%（ 1 140/1 165）. PD cannulation success rate by trainees was 39. 3% （11/28）and the overall success rate was 89. 3% （25/28）. The overall complication incidence was 8.0% （96/1 193）and the incidence of post-ERCP pancreatitis was 4. 4%（53/1 193）. Multivariate logistic regression analysis showed that the selective cannulation by trainees was more likely to fail in patients with malignant biliary stricture（ OR=0. 44, 95%CI： 0. 28-0. 67, P〈0. 01）, benign or undetermined biliary stricture（ OR = 0. 32, 95% CI： 0. 17-0. 60, P〈0. 01 ）, suspected sphincter of Oddi dysfunction （ SOD ） （ OR = 0. 28, 95% CI： 0. 16-0. 47, P 〈 0. 01 ）, coexisting hypertension （ OR = 0. 65, 95%CI： 0. 44-0. 96, P〈0. 05）, RDW 〉148 fL（ OR = 0. 69, 95% CI： 0. 51-0. 92, P〈0. 05）, PLT〈 100× 109/L （OR= 1.68, 95%CI： 1.05-2.71, P〈0.05）. Conclusion Biliary stricture, suspected sphincter of Oddi dysfunction, coexisting hypertension, abnormal RDW and PLT were independent risk factors influencing cannulation success rate by trainees during hands-on ERCP training.

关 键 词：内镜下逆行胆胰管造影术 选择性插管 培训 

分 类 号：R57[医药卫生—消化系统]