内镜下胰管括约肌切开术后早期并发症的前瞻性研究

A prospective study of early complications in endoscopic pancreatic sphincterotomy

目的评价内镜下胰管括约肌切开术后早期并发症的发生率及相关危险因素。方法前瞻性观察2006年5月至2007年4月行ERCP的住院患者，将ERCP下行胰管括约肌切开术的患者纳入研究。在ERCP术前及术中分别将患者和操作相关情况记录在统一的观察表上；术后随访并发症的发生情况直至出院；有关数据进行统计学分析。结果在纳入观察的165例行胰管括约肌切开术的患者中，25例发生并发症（15．2％），其中急性胰腺炎22例（13．3％，轻度15例、中度6例、重度1例），出血1例（0．6％），急性胆管炎2例（1．2％），无穿孔或操作相关的死亡发生。多变量分析提示术后急性胰腺炎危险因素是：女性（OR=3．8，95％CI1．4～10．8）、复发性胰腺炎（OR=3．1，95％CI1．0-9．9）、副乳头切开术（OR=5．9，95％CI1．2—28．8）。结论与常规ERCP操作比较，内镜下胰管括约肌切开术后急性胰腺炎的发生率较高。特别是女性、复发性胰腺炎、行副乳头切开术的患者，术后更易发生急性胰腺炎。

Objective To investigate the rate and risk factors of early complications after endoscopic pancreatic sphincterotomy. Methods Data of patients, who underwent endoscopic pancreatic sphincterotomy from May 2006 to April 2007, were recorded before and during the procedure and prospectively studied. The patients were followed up until discharge. Results A total of 165 patients underwent endoscopic pancreatic sphincterotomy, of which 25 （ 15.2% ） developed complications, including acute pancreatitis in 22 （ 13.3% ） （ 15 mild, 6 moderate and 1 severe）, hemorrhage in 1 （0. 6% ）, and acute cholangitis in 2 （ 1.2% ）. There was no perforation or procedure-related mortality. Multivariate analysis indicated that risk factors of acute pancreatitis were female （ OR ： 3.8, 95% CI ： 1.4 - 10. 8）, recurrent pancreatitis （ OR ： 3. 1, 95% CI ： 1.0 - 9. 9）, and parapapilla sphincterotomy （ OR ： 5.9, 95% CI ： 1.2 - 28. 8）. Conclusion Compared with routine ERCP, endoscopic pancreatic sphincterotomy may be associated with higher risk of acute pancreatitis, especially in women, patients with recurrent pancreatitis and those undergoing parapapilla sphincterotomy.