治疗性ERCP并发症分析及其防治体会

Managements and prevention of complications after endoscopic retrograde cholangiopancreatography

目的降低胆胰疾病患者尤其是老年患者治疗性ERCP并发症的发生率，提高其安全性。方法回顾性分析近2年930例（其中≥60岁患者510例）胆胰疾病患者行治疗性ERCP的临床资料，统计并发症发生率。结果930例患者中，ERCP成功896例，成功率96．34％。发生ERCP并发症73例，发生率7．85％；其中胰腺炎42例（合并胆道感染1例），十二指肠穿孔4例，乳头切开后迟发性出血6例，贲门黏膜撕裂出血2例，胆道感染19例（合并感染性休克5例）。2例死亡，余均经治疗后痊愈出院。结论ERCP对胆胰疾病的治疗是较安全有效的，但老年患者脏器功能减退，且合并疾病较多，出现并发症后治疗困难，处理不当可造成严重后果；故要严格掌握ERCP适应证，提高内镜技术，术前、术后积极治疗合并疾病，积极预防并及时诊治并发症。

Objective To investigate the incidence, diagnosis and treatment of complications after endoscopic retrograde cholangiopancreatography （ ERCP）, and to explore the ways of prevention. Methods Clinical data of 930 subjects, in which 510 were older than 60, with cholangiopancreatic diseases who underwent ERCP in the past 2 years were retrospectively analyzed. Results Success rate of ERCP was 96. 54% （896/930）,and the postoperative complication incidence was 7.85% （75/930）. Of all the complications, there were 42 cases of acute pancreatitis, among which 1 was accompanied with biliary tract infection, 4 cases of duodenum perforation, 6 delayed hemorrhage, 2 cardiac dilacerations bleeding, and 19 biliary tract infection （5 combined with infectious shock）. All subjects with complications were cured except for 2 deaths. Conclusion ERCP is a safe and effective method for elderly patients. However, due to decreased organ functions and other underlying diseases, complications after ERCP in elderly patients are usually difficult to manage. The key factors in prevention of complications after ERCP includes in obedience to indications, improvement in procedure skills, treatment of accompanied diseases before and after ERCP, and active management of complications.