治疗性内镜逆行胰胆管造影术后十二指肠乳头出血的客观危险因素分析  

Risk factors and countermeasures for ERCP related duodenal papilla hemorrhage

作　　者：梅永[1] 贾继虎[1] 曾鹏飞[1] 王俊[1] 王国兴 杜超[1] 刘凯[1] 李文平 冯春林[1] 冷凯[1] 陈炜[1] 

机构地区：[1]遵义医学院第三附属医院(遵义市第一人民医院)肝胆外科,贵州遵义563000

出　　处：《中国内镜杂志》2017年第9期6-10,共5页China Journal of Endoscopy

基　　金：遵义市联合科技研发基金(No:遵市科合社字[2016]06号);贵州省卫生厅科学技术基金(No:gzwjkj2014-2-151);贵州省省长基金(No:黔省专合字[2012]120号)

摘　　要：目的探讨治疗性内镜逆行胰胆管造影(ERCP)术后十二指肠乳头出血的客观危险因素及处理方法。方法回顾性分析遵义医学院第三附属医院收治的890例行治疗性ERCP术患者的临床资料。根据是否发生ERCP术后十二指肠乳头出血,分为出血组和未出血组,探讨出血的客观危险因素及处理方法。结果共51例患者发生ERCP术后十二指肠乳头出血,发生率为5.7%。出血组患者胆总管结石所占比例明显低于未出血组,胆管癌、胰头癌所占比例明显高于未出血组(P<0.05)。出血组患者合并高血压病及十二指肠乳头旁憩室发生率明显高于未出血组(P<0.05)。亚组分析显示出血组患者结石直径>2 cm、结石嵌顿及憩室内十二指肠乳头所占比例明显高于未出血组(P<0.05)。结论胆总管结石嵌顿或直径>2 cm、恶性胆胰肿瘤、合并高血压病或憩室内十二指肠乳头均是ERCP术后十二指肠乳头出血的客观危险因素,重在预防出血,内镜止血安全有效。Objective To investigate the risk factors and countermeasures for endoscopic retrograde cholangiopancreatography （ERCP） related duodenal papilla hemorrhage. Methods Retrospective analysis was performed on the clinical data of 890 patients who underwent ERCE According to whether the patients with ERCP related duodenal papilla hemorrhage, they were divided into the hemorrhage group and the non hemorrhage group. And the risk factors of duodenal papilla hemorrhage and their countermeasures were investigated. Results 51 patients had ERCP related duodenal papilla hemorrhage, and the overall incidence rate was 5.7%. Compared with the non hemorrhage group, the patients proportion of common bile duct stones was lower, but the cholangiocarcinoma and pancreatic head cancer were higher in the hemorrhage group （P 〈 0.05）. The incidence of hypertension and duodenal diverticulum in the hemorrhage group were significantly higher than that in the non hemorrhage group （P 〈 0.05）. Subgroup analysis showed that patients with stone diameter 〉2 cm, stone incarceration and the duodenal papilla into diverticulum in the hemorrhage group were significantly higher than that in the non hemorrhage group （P 〈 0.05）. Conclusion Common bile duct stone diameter 〉2 cm, stone incarceration, malignant biliary and pancreatic cancer, hypertension and duodenal papilla into diverticulum were objective risk factors of ERCP related duodenal papilla hemorrhage, focus on prevention of bleeding. Endoscopic hemostasis was safe and effective.

关 键 词：胆胰疾病 内镜逆行胰胆管造影术 并发症 十二指肠乳头出血 内镜止血 

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