内镜逆行性胰胆管造影术后并发症分析:附461例报告

Analysis of postoperative complications of endoscopic retrograde cholangiopancreatography: a report of 461 cases

目的:探讨经内镜逆行性胰胆管造影(ERCP)术后并发症及其预防、处理。方法:回顾性分析2010年12月—2015年5月在中南大学湘雅医院行ERCP患者资料。结果:461例行ERCP患者中成功394例(85.5%)。影响成功的主要因素为肿瘤、溃疡或其他因素导致乳头阻塞、肠腔狭窄而使内镜或导丝无法通过。394例中出现并发症126例(27.3%),包括ERCP术后胰腺炎(PEP)29例(6.3%),一过性高淀粉酶血症47例(10.2%),胆道感染25例(5.4%),出血22例(4.7%),网篮嵌顿断裂1例(0.2%),胰管支架置入后短时间内堵塞1例(0.2%)。无穿孔病例;死亡4例(0.9%),原因主要为急性胆管炎导致的全身感染。诊断性ERCP术后并发症发生率低于治疗性ERCP(23.4%vs.34.7%,P<0.05)。结论:PEP、胆道感染是ERCP术后常见的有意义的并发症。严格掌握适应证,提高操作水平,合理应用相关药物是减少ERCP术后并发症发生的有效方法。

Objective： To investigate the postoperative complications of endoscopic retrograde cholangiopancreatography （ERCP） and the prevention and treatment strategies. Methods： The clinical data of patients undergoing ERCP in Xiangya Hospital of Central South University from December 2010 to May 2015 were retrospectively analyzed. Results： Among a total of 461 patients undergoing ERCP, successful operation was performed in 394 cases （85.5%）, and the causes for operative failure were mainly due to duodenal papilla blockage and intestinal stricture resulting from tumors, ulcers or other factors, which prevented the passage of endoscope or guide wire. Of the 394 patients, complications occurred in 126 cases （27.3%）, including post-ERCP pancreatitis （PEP） in 29 cases （6.3%）, transitional hyperamylasemia in 47 cases （10.2%）, biliary tract infection in 25 cases （5.4%）, hemorrhage in 22 cases （4.7%）, basket incarceration and breakage in one case （0.2%）, and pancreatic duct stent obstruction in one case （0.2%）; no perforation occurred in any of the cases; 4 cases （0.9%） died, mainly due to systemic infection initiated by acute cholangitis. The incidence of complications of diagnostic ERCP was lower than that of therapeutic ERCP （23.4% vs. 34.7%, P〈0.05）. Conclusion： PEP and biliary tract infections are common and significant complications after ERCP. Strict adherence to the indications of ERCP, improvement in surgical skill and appropriate administration of medication are effective methods for reducing the incidence of post-ERCP complications.