治疗性ERCP并发症分析及防治体会

Prevention and Treatment Strategy of Post-Therapeutic ERCP Complications

目的:探讨胆、胰疾患治疗性经内镜逆行性胰胆管造影术(ERCP)术后并发症的发生原因及防治方法,以降低发生率,提高安全性。方法:回顾性分析我院2010年制定ERCP诊治指南后320例治疗性ERCP患者的临床资料,分析并发症发生原因,统计并发症发生率,并与2010年以前进行比较。结果:ERCP成功280例,成功率87.5%。ERCP术后并发症15例,发生率5.4%,其中胰腺炎4例,高淀粉酶血症6例,急性胆管炎2例,结石嵌顿1例,消化道出血1例,穿孔1例,并发症发生率与2010年以前比较存在统计学差异(P=0.001)。结论:ERCP治疗胆、胰疾病安全有效,但出现并发症后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,预防并及时诊治并发症。制定治疗性ERCP的操作规范可降低并发症的发生。

Objective To study the causes and treatment of complications of pest-therapeutic ERCP cases of biliopanereatic diseases ,so as to improve the safety of therapeutic ERCP and decrease the incidence of complications. Methods Since 2010 that ERCP diagnostic guideline was enacted, clinical data of 320 patients undergoing therapeutic ERCP were retrospectively analyzed. The causes and incidence of complications was evaluated, and then compared with the states of patients treated before 2010. Rasults In 320 patients underwent therapeutic ERCP,280 eases were successfully treated, the success rate was 87.5 %. In 280 patients, pest-therapeutic ERCP complications occurred in 15 cases,including 4 cases of acute pancreatitis, 6 cases of hyperamylasemia,2 cases of acute cholangitis, 1 case of calculus incarcerated in choledochus, 1 case of alimentary tract hemorrhage and 1 case of duodenum perforation after EST,the incidence was 5.4% ,wHch was obviously lower than that before 2010（ P = 0.001 ）. Conclusion ERCP is safe and effective for treating biliopancreatic diseases ,but the improper handling of complications may cause serious consequences,so the operative indication should be controlled strictly and the endoscopic technique should be improved, meanwhile the active treatment of complicating disease before and after operation were also important for decreasing post-therapeutic ERCP complication. The enacting of operative standard of therapeutic ERCP could reduce the incidence of complications.