内窥镜下逆行胰胆管造影术中导丝进入胰管与术后高淀粉酶血症的相关性

The correlation study between guide wire entry into pancreatic duct and postoperative hyperamylasemia in ERCP

目的研究内窥镜下逆行胰胆管造影术(ERCP)术中导丝进入胰管次数及胰管内留置时间同术后高淀粉酶血症的关系。方法收集复旦大学附属华山医院及其仁和医院(华山北院宝山分院)2015年1月至2017年12月231例进行ERCP治疗胆管疾病病人资料,比较不同胰管导丝置入状态下ERCP术后淀粉酶升高的情况并分析高淀粉酶血症发生的相关危险因素。结果导丝进入1、2、3、4次胰管,术后淀粉酶较正常高值分别升高(5.8±3.8)、(6.3±4.2)、(8.1±4.1)、(11.6±4.1)倍,导丝进入胰管的次数不同,术后淀粉酶较正常高值升高倍数差异有统计学意义(F=9.047,P<0.001),而导丝在胰管留置不同时间组间其淀粉酶升高倍数差异无统计学意义(P>0.05)。危险因素分析发现导丝进入胰管超过两次(OR=3.36,95%CI:1.829~6.087,P<0.001),术后未行鼻胆管或胆道支架引流(OR=0.451,95%CI:0.260~0.782,P=0.005)是高淀粉酶血症的危险因素。结论对于困难插管病例应尽早采取双导丝插管技术,尽量避免导丝多次进入胰管,以避免术后高淀粉酶血症及胰腺炎的发生。

Objective To study the relationship between the number of guide wires entering the pancreatic duct as well as the time of indwelling in the pancreatic duct and postoperative hyperamylasemia during endoscopic retrograde cholangiopancreatography(ERCP).MethodsA total of 231 patients undergoing ERCP for the treatment of biliary tract disease were admitted to Huashan Hospital and Renhe Hospital(Baoshan Branch of North Huashan Hospital)Affiliated to Fudan University from January 2015 to December 2017.The amylase levels after ERCP were compared among different conditions of guide wire entering pancreatic ducts and the risk factors associated with hyperamylasemia were analyzed.ResultsWhen the guide wire entered the pancreatic duct for1,2,3 and 4 times,the amylase was(5.8±3.8),(6.3±4.2),(8.1±4.1)and(11.6±4.1)times higher than upper limit of normal range respectively after the operation.There was statistically significant difference in the times of amylase increase after the introduction of guide wire into the pancreatic duct at different times(F=9.047,P<0.001),while there was no statistically difference in the times of amylase increase between the two groups when the guide wire was retained in the pancreatic duct at different times(P>0.05).The analysis for risk factors found that more than two times of entry of the guide wire into the pancreatic duct(OR=3.36,95%CI:1.829-6.087,P<0.001),and no nasobiliary or biliary stent drainage(OR=0.451,95%CI:0.260-0.782,P=0.005)were risk factors for hyperamylasemia.Conclusion For patients with difficult intubation,double-guide wire intubation should be adopted as early as possible to avoid the guide wire fromentering the pancreatic duct multiple times to prevent postoperative hyperamylasemia and pancreatitis.