治疗性ERCP术后相关并发症的防治

Prevention and treatment of complications of therapeutic endoscopic retrograde cholangiopancreatography

目的探讨经内镜逆行胰胆管造影(ERCP)术后相关并发症的发生原因、临床表现、治疗方法及效果。方法对2003年5月—2008年12月施行的4 810例ERCP患者的临床资料进行回顾性分析。结果 4 810例ERCP中,共发生并发症245例(5.1%),其中急性胰腺炎113例(2.3%),急性胆管炎76例(1.6%),消化道出血33例(0.7%),十二指肠穿孔4例(0.1%),败血症及脓毒败血症19例(0.4%)。死亡2例(0.04%),1例为EST术后十二指肠穿孔,全身多器官功能衰竭死亡;另1例为ERCP术后发生毛细胆管炎,肝功能衰竭死亡。反复多次胰管显影是ERCP术后发生急性胰腺炎的最主要原因,胆道梗阻因素的存在导致胆道引流不畅是发生胆道感染、败血症等的重要因素,十二指肠穿孔发生率不高但后果严重,需及时积极处理。结论严格掌握ERCP及EST的适应证和禁忌证,掌握娴熟的操作技巧,造影后保持胆道引流通畅并严密观察病情变化,可以减少并发症的发生,提高治疗性ERCP的安全性。

Objective To investigate the causes,clinical manifestation,treatment and therapeutic effect of the complications of therapeutic endoscopic retrograde cholangiopancreatography（ERCP）. Methods The clinical datas of 4 810 cases of therapeutic ERCP performed in our center from May 2003 to December 2008 were analyzed retrospectively. Results Among the 4 810 cases of ERCP,245 cases were accompanied with complications,including 113 cases of acute pancreatitis,76 cases of acute cholangitis,33 cases of alimentary tract hemorrhage;1 death from multiple organ failure caused by duodenum perforation after EST,and 1 death from acute cholangiolitis accompanied by liver function failure.The mortality and the occurrence rate of complications after therapeutic ERCP was 0.04% and 5.2%,respectively. Conclusions Strictly adhering to the indications and contraindications of ERCP and EST,skillful manipulation,adequate drainage of biliary tract and close observation of changes in patients′candition after ERCP,could diminish the complications and improve the safety of therapeutic ERCP.