新冠肺炎疫情期间内镜逆行胰胆管造影术的必要性和安全性

Necessity and safety of endoscopic retrograde cholangiopancreatography during Coronavirus Disease-2019 pandemic

目的:分析新型冠状病毒肺炎(新冠肺炎,COVID-19)疫情期间开展内镜逆行胰胆管造影术(ERCP)的必要性及安全性,并分享经验体会。方法:回顾性分析2020年1月17日至5月19日在瑞金医院外科及急诊科174例ERCP治疗的病人作为研究组。病人的收治管理严格按照瑞金医院新冠肺炎防控措施执行,对病人及相关医务人员全程随访监测。去年同期收治的230例作为对照组,分析比较两组临床资料和治疗结果,包括临床特征、指征、ERCP操作项目和时间、并发症发生和住院时间。结果:研究组胆胰管恶性梗阻的收治比例比对照组显著增加[52(29.9%)比41(17.8%),P=0.004],而择期2次ERCP明显降低[2(1.1%)比33(14.3%),P<0.001]。急性胆道感染、胆管结石、胆胰管良性狭窄各项比较,差异无统计学意义。研究组ERCP取石比例显著低于对照组[40(35.7%)比92(61.3%),P<0.001],而总体胆道支架植入比例则明显升高[101(58.0%)比100(43.5%),P<0.001]。两组并发症发生率相似。研究组平均住院时间显著缩短1.6 d(4.7 d比6.3 d,P<0.001)。研究期间所有病人及参与诊疗的医务人员均未发现感染新冠肺炎。结论:新冠肺炎疫情期间,ERCP仍具有重要的临床应用价值。在执行严格防控措施并优化诊疗流程的前提下,开展ERCP是安全有效的。

Objective To evaluate the necessity and safety of performing endoscopic retrograde cholangiopancreatography(ERCP)during the pandemic of Coronavirus Disease-2019(COVID-19)and to share our experience.Methods Clinical data from 174 patients who underwent ERCP procedures in department of surgery and department of emergency Ruijin Hospital,during the period from 17 January 2020 to 19 May 2020 as study group were analyzed retrospectively.All procedures were carried out under strict protective measures.Data from 230 patients who received ERCP during the same period last year were analyzed as control group.The medical records of patients were compared between two groups including clinical characteristics,indications,ERCP procedure and duration,complications and hospital stay.Results The cases with biliary and pancreatic malignant obstruction in study group(52,29.9%)increased significantly compared with those in control group(41,17.8%)(P=0.004),while the patients of scheduled second ERCP significantly decreased[2(1.1%)vs.33(14.3%),P<0.001].No significant differences were present in other indications.Less cases with complete stone clearance[40(35.7%)vs.92(61.3%),P<0.001]and more cases with plastic biliary stent insertion[101(58.0%)vs.100(43.5%),P<0.001]were found in study group compared with control group.The complications of ERCP remained low as usual and the length of hospital stay in study group shortened 1.6 days significantly(4.7 d vs.6.3 d,P<0.001).Neither patients nor medical staff infected with COVID-19 during study period.Conclusions During the period of COVID-19 pandemic,the demand in treatment of ERCP was similar as usual showing that it is important in clinic.It is effective and safe to perform ERCP under the premise of adopting strong prevention and control strategies.