ERCP术后重症急性胰腺炎6例临床分析

Post-ERCP severe acute pancreatitis:a clinical analysis of 6 cases

目的探讨ERCP术后急性胰腺炎(PEP)的预防及治疗方法。方法回顾性总结南京军区南京总医院普通外科2006年4月至2009年8月由外院转入的6例ERCP术后重症急性胰腺炎病例资料,分析临床诊疗经过及预后。结果 6例病人中5例因胆道症状、1例因右上腹痛行ERCP检查,其中1例病人反复插管后置管失败,2例行胰管造影检查,3例行Oddi括约肌预切开术,均未行Oddi括约肌球囊扩张及胰管括约肌切开术,术前、术后均未预防性用药,术后均未放置胰管支架;6例病人在ERCP术后8～48h诊断为SAP,急性期有4例病人并发急性肺损伤,1例并发急性呼吸窘迫综合征(ARDS),1例并发ARDS、急性肾功能衰竭,后期有5例病人并发胰腺坏死组织感染而行手术引流,1例死亡。结论严格掌握ERCP适应证、术前充分评估病人危险因素、术中注意避免操作相关危险因素、术后早期诊断,是预防及治疗PEP的关键。

Objective To analyze the prevention and therapy of post-ERCP pancreatitis. Methods The clinical characteristics of 6 post-ERCP pancreatitis patients admitted between April 2006 and August 2009 at Nanjing General Hospital of Nanjing Military Command were summarized by retrospective analysis, and the clinical procedures and outcomes were analyzed. Results ERCP was performed for different causes. One patient was failed to cannulation repeatedly, 2 patients had pancreatic tube injection, 3 patients had Oddi-sphinctcrotomy, none of them had balloon dilatation of the intact biliary sphincter or pancreatic sphincterotomy. No prophylaxis medication was administered pre/ post-ERCP, and no pancreatic tube stand was performed. Patients had diagnosis of SAP in 8 to 48 hours after ERCP. In early stage , 4 patients complicated with ALI, 1 patient complicated with ARDS, while 1 patient complicated with both ARDS and ARF. In the following stage, 5 patients had pancreatic debridement because of infection of pancreatic necrosis. One patient died of PEP. Conclusion Indications of ERCP should be strictly controlled. Evaluation of risk factors before ERCP, avoidance of high-risk performance during the process and early diagnosis of post-ERCP pancreatitis is of invaluable importance to prevent and treat PEP.