治疗性经内镜逆行胰胆管造影术后胆道出血与原发疾病的关系  

Association between hematobilia and primary disease after therapeutic endoscopic retrograde cholangiopancreatography

作　　者：王群茹 张勇[1] 牟东[1] 陈备金 倪华[1] 高慧[1] 

机构地区：[1]成都军区总院消化科,成都610081

出　　处：《临床肝胆病杂志》2017年第5期896-898,共3页Journal of Clinical Hepatology

摘　　要：目的分析不同原发疾病类型患者行治疗性经内镜逆行胰胆管造影(ERCP)术后胆道出血的风险差异。方法回顾性分析2013年6月-2016年6月成都军区总医院收治的685例行治疗性ERCP的胰胆疾病患者临床资料。根据患者是否发生ERCP术后胆道出血,分为出血组(29例)和未出血组(656例),评价原发疾病类型与出血风险之间的关系。计数资料2组间比较采用χ~2检验;计量资料2组间比较采用独立样本t检验。结果 ERCP术后胆道出血的总体发生率为4.2%(29/685);其中21例为早期出血,8例为迟发性出血。出血组患者合并高血压病发生率明显高于未出血组(65.5%vs 25.6%,χ~2=22.286,P<0.001)。出血组壶腹部嵌顿结石(17.2%vs 4.6%,χ~2=9.193,P=0.002)、胆管癌(10.3%vs 2.4%,χ~2=6.437,P=0.011)、胰腺癌(10.3%vs3.0%,χ~2=4.556,P=0.033)及壶腹部癌(6.9%vs 1.4%,χ~2=5.356,P=0.021)所占比例明显高于未出血组。2组患者胆总管结石、急性化脓性胆管炎、急性胆源性胰腺炎、胆管炎性狭窄及胆道术后胆管狭窄所占比例比较,差异均无统计学意义(P值均>0.05)。结论壶腹部嵌顿结石及恶性胆胰疾病患者ERCP术后胆道出血的风险更大,对于此类患者重在术前充分准备、术中有效止血及术后加强预防。Objective To investigate the difference in the risk of hematobilia after therapeutic endoscopic retrograde cholangiopancreatography （ERCP） in patients with different primary diseases. Methods A retrospective analysis was performed for the clinical data of 685 patients with pancreaticobiliary diseases who underwent therapeutic ERCP in General Hospital of Chengdu Military Region from June 2013 to June 2016. According to the presence or absence of hematobilia after ERCP, they were divided into bleeding group （29 patients） and non - bleeding group （656 patients）. The association between primary disease and the risk of bleeding was evaluated. The chi -square test was used for comparison of categorical data between groups, and the independent samples t - test was used for comparison of continuous data be- tween groups. Results The overall incidence rate of hematobilia after ERCP was 4.2% （29/685）, and among these patients, 21 had early bleeding and 8 had delayed bleeding. The bleeding group had a significantly higher incidence rate of hypertension than the non - bleeding group （65.5% vs 25.6% , X2 =22. 286, P 〈0. 001 ）. Compared with the non - bleeding group, the bleeding group had significantly higher proportions of patients with impacted ampullar stones （ 17.2% vs 4.6% , X2 =9. 193, P =0. 002）, cholangiocareinoma （ 10.3% vs 2.4% , X2 = 6. 437, P = 0.011 ）, pancreatic cancer （ 10.3 % vs 3.0%, X2 = 4. 556, P = 0. 033 ）, and ampullar carcinoma （6.9% vs 1.4%, X2 = 5. 356, P = 0. 021 ）. There were no significant differences between the two groups in the proportions of patients with common bile duct stones, acute pyogenic cholangitis, acute biliary panereatitis, bile duet inflammatory stenosis, and bile duct stenosis after bile duct surgery （ all P 〉 0.05）. Conclusion Patients with impacted ampullar stones or malignant panereaticobiliary diseases have a high risk of hematobilia after ERCP and should be given adequate preoperative preparation, effective intraoperative hemostasis,

关 键 词：胰胆管造影术 内窥镜逆行 胆道出血 手术后并发症 

分 类 号：R657.4[医药卫生—外科学] R657.5[医药卫生—临床医学]