经内镜逆行胰胆管造影术后并发症的危险因素分析

Risk factors for ERCP-related complications： a review of 1 951 cases

目的探讨经内镜逆行胰胆管造影术（ERCP）术后并发症的危险因素。方法回顾性分析2011年1月1日到2013年12月31日于南昌大学第一附属医院消化内镜中心行ERCP的1951例住院患者资料，对于ERCP出现并发症的病例行单因素及多因素分析，探讨ERCP术后并发症的危险因素。结果1951例病例中，出现并发症277例。ERCP术后胰腺炎101例（5．18％）；并发高淀粉血症（不包括胰腺炎）54例（2．77％）；并发胆道感染134例（6．87％）；并发上消化道出血8例（0．41％），并发肠梗阻1例（0．05％）及十二指肠穿孔1例（0．05％）。多因素分析显示胆管癌（P=0．002，OR=2．39，95％CI：1．38～4．14）、ERCP手术时间超过60min（P=0．020，OR=3．77，95％CI：1．23—11．53）、内镜下乳头括约肌切开术（EST）（P=0．008，OR=2．56，95％CI：1．28～5．14）、ERCP术中导丝进入胰管（P=0．012，OR：1．43，95％CI：1．08～1．87）为术后胰腺炎的独立危险因素；胆管癌（P〈0．01，OR=2．93，95％CI：1．88～4．56）及住院期间多次行ERCP（P〈0．01，OR=2．53，95％CI：1．63～3．93）为术后胆道感染的独立危险因素，行EST（P=0．03，OR=0．65，95％CI：0．44～0．97）及ERCP术后预防性使用抗生素（P=0．03，OR=0．64，95％CI：0．39～0．95）为术后胆道感染的保护因素。结论胆管癌、行EST、ERCP手术时间超过60min及术中导丝等器械进入胰管均易发生ERCP术后胰腺炎。胆管癌、住院期间多次行ERCP术易增加ERCP术后胆道感染的发生，而行EST及术后预防性使用抗生素可减少术后胆道感染的发生。

Objective To investigate the risk factors for post-ERCP complications. Methods Data of the patients who underwent ERCP in the First Affiliated Hospital of Nanchang University from 1 January 2011 to 31 December 2013 were retrospectively analyzed. Post-ERCP complications were analyzed by univariate and multivariate analyses. Results A total of 277 patients out of 1 951 developed complications, 101 （ 5. 18%） pancreatitis, 54 （2.77%） hyperamylasemia （ not including pancreatitis ）, 134 （ 6. 87%） biliary infection, 8 （0.41%） hemorrhage, 1 （0.05%） obstruction and i （0.05%） perforation. Multivariate analyses showed cholangiocarcinoma （P= 0. 002, OR= 2. 39, 95% CI： 1.38-4. 14） , long operation time（ 〉 60 min） （P=0. 020, 0R=3.77, 95%CI：1.23-11.53） and endoscopic sphincterotomy （EST） （P=0. 008, OR= 2. 56, 95% CI： 1.28-5. 14） and entrance of guidewire to pancreatic duct （ P = 0. 0i2, OR = 1.43, 95%C1：1.08-1.87） were independent risk factors for PEP. Cholangiocarcinoma （P〈 0. 01, OR = 2. 93, 95%C1： 1.88-4. 56） , multiple times of ERCP during the period of hospitalization （ P〈0. 01, OR = 2. 53, 95%CI： 1.63-3.93） were independent risk factors for post-cholangitis. However, EST （ P = 0. 03, OR =0. 65,95% CI：0. 44-0. 97） and antibiotics prophylaxis after ERCP （ P = 0. 03, OR = 0. 64, 95% CI： 0. 39- 0. 95 ） were protective factors for post-cholangitis. Conclusion Cholangiocarcinoma, endoscopic sphincterotomy, long operation time （〉 60 min ） and entrance of guidewire to pancreatic duct were independent risk factors for PEP. Cholangiocarcinoma and multiple ERCP during the period of hospitalization are independent risk factors for post-cholangitis. EST and antibiotics prophylaxis after ERCP might reduce the occurrence of cholangitis.