目的 探讨早期预切开时间对困难插管患者内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)术后胰腺炎发生率的影响。方法 回顾性分析武警安徽总队医院从2014-03至2019-11行ERCP因困难插管而预切开符合条件患者临床资料,共187例,根据预切开时间分成两组,早期预切开(A组)85例,延迟预切开(B组)102例,对两组患者的基本情况、与患者自身及手术操作相关的ERCP术后胰腺炎(post-ERCP pancreatitis, PEP)高风险因素、预切开后插管成功率及术后发生胰腺炎情况进行比较。两组均未给予吲哚美辛栓纳肛,术后均未放置胰管支架。结果 A组ERCP术后胰腺炎(post-ERCP pancreatitis, PEP)发生率为4.71%(4/85),B组PEP发生率为14.71%(15/102),A组发生率低于B组, 差异有统计学意义(P<0.05)。A组4例PEP均为轻度胰腺炎;B组15例PEP中1例为重度胰腺炎,其余为轻度胰腺炎。两组预切开后选择性胆管插管成功率,A组为92.94%(79/85),B组为85.29%(87/102)。两组术后出血、穿孔、胆管炎等并发症发生率无统计学差异,两组均无死亡病例。结论 对ERCP手术困难插管患者,早期预切开可降低PEP发生率,提高插管成功率,安全有效。
Abstract
Objective To investigate the effect of early precut sphincterotomy on the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP) in patients with difficult biliary access.Methods According to the precut time, 187 patients who were referred to Anhui Provincial Corps Hospital of Chinese People's Armed Police Force for ERCP due to difficult biliary cannulation between March 2014 and November 2019 were divided into the early precut group (group A,n=85) and the delayed precut group (Group B,n=102). The success rate of cannulation and the incidence of PEP were compared between the two groups. No rectal indomethacin or pancreatic stent was used for prevention of PEP.Results The incidence of PEP was 4.71%(4/85)in group A and 14.71%(15/102)in group B, so the difference was statistically significant (P<0.05). One of the 15 cases of PEP was severe in group B. There was no significant difference in the incidence of postoperative bleeding, perforation, cholangitis or other complications between the two groups. There was no mortality in either group.Conclusions In patients with difficult biliary cannulation, early precut sphincterotomy is an effective approach and can significantly reduce the incidence of PEP.
关键词
早期预切开 /
困难插管 /
ERCP术后胰腺炎
Key words
early precut sphincterotomy /
difficult biliary access /
post-endoscopic retrograde cholangiopancreatography pancreatitis
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