肝硬化合并胆总管结石患者行ERCP的临床分析  

ERCP for treatment of choledocholithiasis in patients with liver cirrhosis

作　　者：张敬坡[1] 冯雷[1] 秦静[1] 张海涛[1] 张传宝[1] 孙江义[1] 

机构地区：[1]河北省石家庄市第三医院,石家庄050017

出　　处：《肝胆外科杂志》2017年第6期457-460,共4页Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝硬化合并胆总管结石病人接受ERCP术的危险性,以及相应的应对措施。方法回顾性分析2010年1月至2016年6月该科收治的肝硬化合并胆总管结石病人135例,其中成功接受ERCP术102例(观察组),及随机抽取同期接受ERCP术诊治且无肝硬化病史的胆总管结石患者120例(对照组),对比分析ERCP术中术后并发症发生情况,以及病死率。结果观察组中26例(25.5%)为Child-Pugh A级,53例(52.0%)为Child-Pugh B级,23例(22.5%)为ChildPugh C级;18例(17.6%)出现1种或1种以上并发症,以出血、诱发感染、术后胰腺炎为常见并发症;病死率0(0/102);在ERCP术后出血率上两组间存在显著性差异。结论肝硬化合并胆总管结石病人ERCP诊疗过程中的耐受程度良好;ChildPugh分级是决定内镜治疗方式和判断预后的重要参考指标;对肝硬化失代偿者行微创治疗仍具有一定风险,严重并发症主要为术后出血,采取有效的预防和止血措施,有更多的肝硬化合并胆总管结石病人仍能受益于内镜治疗。Objective To review the risk factors of ERCP in cirrhosis accompanied with choledocholithiasis to find appropriate strategies. Methods In this study, we reviewed 135 cases of cirrhosis accompanied with choledocholithiasis in a public hospital in Chi- na from January 2010 to June 2016, and retrospectively evaluated a group of symptomatic cirrhotic （ n = 102,102/135 ） and non-cirrhot- ic （120） patients subjected to ERCP. The groups were compared for trans-ERCP and post-ERCP complications, mortality rates. Results Twenty-six（25.5） of the patients of the cirrhosis-ERCP group were classified as Child-Pugh A,Fifty-three（52.0% ） Child-Pugh B, and Twenty-three （ 22. 5 ） Child-Pugh C. Complications happened in Eighteen （ 17.6 ） of EG, including bleeding,infection, pancreati- tis. And difference between the two groups was occurrence of post ERCP bleeding. Conclusion Patients with cirrhosis have considera- ble tolerance during ERCP to treat their biliary tract disease. Child-Pugh classification is the determinative factor of ERCP treatment plans and the most important predictor of outcome. The main server complication was Post ERCP bleeding, we had satisfied curative effects by endoscopic injection homeostasis and oral applications of thrombinum.

关 键 词：肝硬化 ERCP 并发症 

分 类 号：R657.4[医药卫生—外科学]