肝硬化患者治疗性ERCP操作的安全性和有效性分析

Study on the efficacy and safety of therapeutic ERCP in patients with liver cirrhosis

目的探讨肝硬化合并胆胰疾病患者进行经内镜逆行胰胆管造影(ERCP)操作的效果及安全性。方法回顾性对比研究47例肝硬化患者(肝硬化组)和150例同期接受ERCP治疗的非肝硬化患者(对照组)进行治疗性ERCP的情况和ERCP相关并发症的发生率。结果肝硬化组中Child-Pugh分级A级16例,B级18例,C级13例。治疗性ERCP前纠正肝硬化患者的凝血障碍。肝硬化组中共发生5例ERCP相关并发症,并发症发生率为10.64%,其中包括3例ERCP术后胰腺炎(6.38%),1例吸入性肺炎(2.13%),1例死亡(2.13%);对照组中有22例发生ERCP相关并发症,并发症发生率为14.67%,其中包括16例术后胰腺炎(10.67%),术后胆道感染6例(4%);两组间并发症发生率无统计学差异(P<0.05)。两组均未发生术后出血及穿孔。肝硬化组术中出血发生率为10.64%,高于对照组的术中出血率(3.33%),但差异无统计学意义(P>0.05)。结论肝硬化患者ERCP术后并发症发生率与普通人群相比无统计学差异,对于肝硬化合并胆胰疾病的患者,ERCP是安全有效的选择。

Objective To explore the efficacy and safety of endoscopic retrograde cholangiopancreatography （ERCP）in patients with liver cirrhosis. Methods The clinical data of 47 cirrhotic patients underwent therapeutic ERCP in this hospital and ERCP - related complications were compared with those of 150 non - cirrhotic patients. Results A total of 47 patients with liver cirrhosis and 150 non - cirrhotic patients were in-cluded in this study. There was no statistically difference between these two groups with regard to age,sex and ERCP indications. White blood cell count,platelet count,INR （International Normalized Ratio）and serum level of albumin in cirrhotic patients were significantly different from those in non - cirrhotic patients （P 〈 0. 05）. A total of 16 patients with Child - Pugh （CP）class A,18 patients with CP class B,and 13 patients with CP class C. Thrombocytopenia and coagulopathy were corrected before ERCP. ERCP - related complications occurred in 5 cases （10. 64%）of cirrhotic group,and these complications included post - ERCP pancreatitis （n = 3,6. 38%）,aspiration pneumonia （n = 1,2. 13%）and death （n = 1,2. 13%）. There were 22 cases （14. 67%）complicated with ERCP - related complications in non - cirrhotic group which included post- ERCP pancreatitis （n = 16,10. 67%）and cholangitis （n = 6,4 %）. There was no perforation,cholecystitis and post - ERCP bleeding in both two groups. The incidence of intraoperative hemorrhage in cirrhotic patients （10. 64%）was higher than that of non - cirrhotic patients （3. 33%）, although the difference was not statistically significant （P 〉 0. 05）. Conclusion The adverse events seen in patients with cirrhosis are similar to those seen in general population of patients undergoing ERCP. ERCP is a safe and effective procedure for cirrhotic patients.