ERCP与EST并发出血的相关临床研究

Clinical research on the bleeding in ERCP and EST

目的:研究胆总管结石经内镜逆行性胰胆管造影术(ERCP)与十二指肠乳头切开术(EST)并发出血的相关危险因素,并探讨有效防治措施。方法:研究性分析皖南医学院弋矶山医院消化内镜中心2012年1月至2012年12月299例胆总管结石患者行ERCP与EST取石术的临床资料。结果:299例患者,术中少量出血52例,明显出血50例,成功插入乳头时间经方差分析(F=3.713)差异有统计学意义(P=0.026,P<0.05);出血病例中,存在憩室21例,出血量与憩室的关系经卡方检验(χ2=5.314)差异有统计学意义(P=0.021,P<0.05);术中出血患者分别采用内镜下电凝止血与钛夹止血处理,经Fisher精确概率检验法,提示内镜下钛夹止血治疗的止血有效率高于电凝止血治疗(P=0.044,P<0.05);并发术后出血11例,药物止血6例,4例止血无效,内镜止血5例,均有效止血,经Fisher精确概率检验法,提示内镜下止血有效率高于药物止血(P=0.045,P<0.05)。结论:胆总管结石ERCP与EST并发出血与成功插入乳头时间,有无憩室等因素相关,内镜下干预治疗是防治术中术后出血的有效措施。

The clinical research of the bleeding in ERCP and EST Objective To analyze the concurrent bleeding-related causes and identify effective prevention measures of common bile duct stones by ERCP and EST. Methods Retrospectively analyze 299 cases of common bile duct stones underwent ERCP and EST lithotomy clinical data of Digestive Endoscopic Center in Yijishan Hospital of Wannan Medical College from January 2012 to December 2012. Results The 299 patients,52 cases of less bleeding and 50 cases of significant bleeding in surgery, the difference of the time inserting nipple by analysis of variance （F = 3.713） was statistically significant （P = 0.026, P 〈0.05）; in the bleeding cases, 21 cases of diverticulum, the difference of the relationship between the amount of bleeding and diverticula by the chi-square test （x2 = 5.314）was statistically significant （P = 0.021, P 〈0.05）; the Fisher exact test shows that hemostasis titanium clips under endoscopic is more efficient than electric coagulation therapy （P = 0.464, P 〈0.05）, in 8 cases of postoperative bleeding , 3 cases of conservative treatment is effective , one case is invalid, three cases of endoscopic hemostasis treatment is effective, and a case complicated by severe acute pancreatitis after intervention hemostasis. Conclusion The concurrent bleeding of common bile duct stones by ERCP and EST is related to the time of successfully inserting the nipple, and the exist of diverticulitis, endoscopic hemostasis treatment is the effective measure of preventing and treating bleeding.