儿童经内镜逆行胰胆管造影术后并发症分析

Complications of endoscopic retrograde cholangiopancreatography in children with pancreaticobiliary diseases

目的研究经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)在儿童胆胰疾病诊治中并发症的发生情况、影响因素及相应处理,以探讨其安全性、有效性。方法回顾分析2008年1月至2017年12月期间于杭州市第一人民医院消化内科住院接受ERCP诊治的共172例16岁以下患儿的临床资料,对麻醉方式、疾病诊断、治疗方法、术后并发症情况进行研究分析。结果172例患儿共接受375次ERCP操作,胆道疾病210例次(56.0%),胰腺疾病245例次(65.3%)。分别完成胆、胰管开口切开,胆、胰管取石,胆、胰管内支架置入,鼻胆管、鼻胰管引流等相关操作。操作成功率为99.5%(373/375),操作相关并发症的发生率为6.7%(25/375),包括13例次(3.5%)术后胰腺炎,8例次(2.1%)术后出血,6例次(1.6%)术后胆管炎,并发症均于治疗后缓解。无重症胰腺炎、穿孔、ERCP相关死亡发生。首次ERCP操作及反复多次插管的术后胰腺炎风险更高(P<0.05),十二指肠乳头切开患儿术后出血风险更高(P<0.05)。结论儿童ERCP术后并发症发生率与成人相近,并且与治疗方法有关,内镜医师应高度重视并及时处理并发症。由经验丰富的内镜医师选择合适的方法操作时,儿童ERCP仍可被视为安全、有效的。

Objective To study the incidence,influencing factors and corresponding treatment of complications of endoscopic retrograde cholangiopancreatography(ERCP)in children with pancreaticobiliary diseases.Method Clinical data of 172 children aged under 16 years with pancreaticobiliary diseases receiving ERCP between January 2008 and December 2017 in Hangzhou First People′s Hospital were studied retrospectively.Anesthesia type,diagnosis,therapeutic methods and postoperative complications were analyzed.Results A total of 375 ERCP procedures were performed on 172 patients,among whom there were 210 cases(56.0%)of bile duct diseases and 245(65.3%)pancreatic diseases.Dissection of pancreatic duct and biliary duct,calculus removal,insertion of endoprosthesis and drainage of pancreatic duct or biliary duct were performed.The success rate of ERCP was 99.5%(373/375).The incidence of complications was 6.7%(25/375)including 13 cases(3.5%)of post-ERCP pancreatitis,8 cases(2.1%)of bleeding,and 6 cases(1.6%)of postoperative cholangitis.All the complications were cured.No severe pancreatitis,perforation or ERCP-related death occured.The first ERCP procedure and repeated cannulations were the risk factors of post-ERCP pancreatitis(P<0.05).Children had higher risk of post-ERCP bleeding after endoscopic sphincterotomy(P<0.05).Conclusion The incidence of post-ERCP complications in children is similar to that of adults and is related to therapeutic methods.More attention and timely treatment should be given to those children.ERCP can be effectively and safely for children operated by an experienced endoscopic physician with appropriate therapeutic methods.