胆漏的位置可能是影响首次内镜逆行胰胆管造影术成功的相关因素

Location of Bile Leakage may be a Relevant Factor Influencing the Success of the First ERCP

【目的】探究胆漏的位置可能是影响首次内镜逆行胰胆管造影术(ERCP)成功的相关因素。【方法】回顾性分析广州医科大学附属第二医院自2012年6月至2017年4月行肝胆手术后疑似胆漏患者的临床资料。所有患者均行ERCP,分为胆囊管漏组(9例)和肝内胆管漏组(10例),统计分析白细胞计数、肝功能变化及治愈情况。【结果】19例患者均顺利完成治疗,术后未出现出血、穿孔、感染休克等严重并发症。两组患者手术前后白细胞计数、肝功能及改善情况比较差异无统计学意义(P>0.05)。把首次ERCP成功者分为A组(n=11),失败者为B组(n=8)。单因素分析性别、年龄、术前ALT、AST、TBIL及手术类型与首次ERCP成功的影响无统计学意义(P=0.650、P=0.869、P=0.481、P=0.620、P=0.340、P=0.362)。而白细胞计数(P=0.015)及胆漏的位置(P=0.020)有统计学意义。精确Logistic回归分析显示胆漏的位置有统计学意义(P=0.0004,OR=5.448,95%CI=2.347~+∞)。【结论】内镜逆行胰胆管造影术(ERCP)治疗胆漏是安全和有效性的。胆漏的位置可能是影响首次ERCP成功的相关因素。

【Objective】To investigate the location of bile leakage as a relevant factor influencing the success of the first endoscopic retrograde cholangiopancreatography(ERCP)procedure.【Methods】A retrospective analysis was conducted to investigate clinical data coming from the Second Affiliated Hospital of Guangzhou Medical University from June 2012 to April 2017.Data were collected from patients with suspected biliary leakage HBP post-operation.All of the patients having undergone ERCP procedure were divided into the cystic duct leakage group(9 cases)and the intrahepatic bile duct leakage group(10 cases).A statistical analysis was performed on WBC counts,liver function changes,and improvement of the disease.【Results】All of the 19 cases had successfully completed the ERCP treatment with no serious postoperative complications.Especially,GI bleeding,perforation,infection and shock were not found.Unfortunately,no significant differences were observed in WBC counts,liver function changes and improvement between the two groups before and after the operation(P>0.05).Interestingly,the first successful ERCP procedure was assigned as Group A(n=11),the first unsuccessful ERCP procedure was assigned as Group B(n=8).A univariate analysis on the influence of gender,age,preoperative ALT,AST,TBIL and surgery type on the success of the first ERCP procedure had shown no statistical difference(P=0.650,P=0.869,P=0.481,P=0.620,P=0.340,P=0.362),while there were statistical differences in WBC count(P=0.015)and bile leakage location(P=0.020).An exact Logistic regression analysis had shown that there was a significant difference in the location of bile leakage(P=0.0004,OR=5.448,95%CI=2.347~+∞).【Conclusions】Bile leakage treated with ERCP method is safe and effective.The location of bile leakage is a relevant factor influencing the success of the first ERCP procedure.