消化道重建术后ERCP安全性和疗效分析

Safety and efficacy of ERCP after digestive tract reconstruction

目的:探讨消化道重建术后行ERCP治疗的安全性及疗效。方法:回顾性分析2020年1月1日至2021年12月31日在上海交通大学医学院附属新华医院接受ERCP治疗的154例消化道重建术后患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男94例,女60例;年龄6~91岁,中位年龄58岁。消化道重建术式包括Whipple术Child吻合48例,Roux-en-Y术60例,毕Ⅱ式胃大部分切除术46例。由经验丰富医师采用十二指肠侧视镜及单气囊小肠镜辅助行ERCP。观察ERCP操作时间、成功率、治疗成功率、术后并发症发生率等。3组ERCP操作时间比较采用秩和检验,率的比较采用χ^(2)检验。结果:本组154例患者累计进行220次ERCP操作,成功完成胆、胰管插管183次。ERCP操作成功率为83.2%(183/220),临床治疗成功率为80.5%(177/220)。其中Whipple术后组、Roux-en-Y术后组、毕Ⅱ式胃大部分切除术后组ERCP插管成功率分别为86%(66/77)、86%(73/85)、76%(44/58),临床治疗成功率分别为83%(64/77)、82%(70/85)、74%(43/58),差异无统计学意义(χ^(2)=2.276,2.014;P>0.05)。3组ERCP操作时间中位数分别为100(60)、130(93)、74(60)min,差异有统计学意义(H=30.463,P<0.05)。术后胰腺炎6例,均为轻型,经禁食、补液等对症治疗后好转出院。Whipple术后组并发症发生率为1%(1/77),Roux-en-Y术后组为1%(1/85),毕Ⅱ式胃大部分切除术后组为12%(7/58)。结论:消化道重建术后行ERCP治疗是安全、有效的,须严格把握手术适应证,术前充分准备,由经验丰富的医师在团队协作下进行。

Objective To evaluate the safety and efficacy of ERCP after digestive tract reconstruction.MethodsClinical data of 154 patients who underwent ERCP in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 1, 2020 to December 31, 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 94 patients were male and 60 female, aged from 6 to 91 years, witha median age of 58 years. The digestive tract reconstruction techniques included Whipple-Child reconstruction in 48 cases, Roux-en-Y reconstruction in 60, and BillrothⅡsubtotal gastrectomy in 46, respectively. ERCP was performed using lateral-viewing duodenoscope and single-balloon enteroscopy by experienced surgeons. The operation time, success rate, treatment success rate and postoperative complications of ERCP were observed. The operation time of ERCP among 3 groups was compared by rank-sum test. The rate comparison was conducted by Chi-square test.Results154 patients underwent 220 times of ERCP cumulatively, and 183 times of intubation of bile duct and pancreatic duct were successfully completed. The success rate of ERCP was 83.2%(183/220), and the clinical treatment success rate was 80.5%(177/220). The success rates of ERCP intubation after Whipple-Child reconstruction, Roux-en-Y reconstruction and BillrothⅡsubtotal gastrectomy were 86%(66/77), 86%(73/85) and 76%(44/58), respectively, and the clinical treatment success rates were 83%(64/77), 82%(70/85) and 74%(43/58), where no significant differences were observed among3 groups (χ^(2)=2.276, 2.014;P>0.05). The median operation time of ERCP in 3 groups was 100(60), 130(93) and 74(60) min, respectively, and significant differences were observed (H=30.463, P<0.05). Postoperative mild pancreatitis occurred in 6 patients, who were discharged after symptomatic treatments, such as fasting and fluid replacement, etc. The incidence of postoperative complications was 1%(1/77) in the Whipple-Child reconstruction group, 1%(1/85) in Roux-en-Y reconstruction group and 12%(7/58) in BillrothⅡ subtotal gastrectomy group.ConclusionsIt is safe and efficacious to perform ERCP after digestive tract reconstruction. It is necessary to strictly review the surgical indications, make full preparations before ERCP, and should be carried out by experienced surgeons under teamwork.