妊娠期和产褥期患者行内镜逆行胰胆管造影的有效性及安全性对比分析

Efficacy and safety of endoscopic retrograde cholangiopancreatography during pregnancy and puerperium:A comparative analysis

目的对比分析妊娠期和产褥期患者行内镜逆行胰胆管造影(ERCP)的有效性及安全性。方法回顾性分析2007年1月—2022年8月因胆胰疾病在南昌大学第一附属医院消化内镜中心接受ERCP诊疗的妊娠期患者22例、产褥期患者39例的临床资料。收集并比较两组患者基线资料、ERCP术中诊断、干预措施、ERCP诊疗前后实验室检查结果、ERCP术后并发症、分娩结局和胎儿结局等数据。计量资料两组间比较采用成组t检验。计数资料两组间比较采用χ^(2)检验或Fisher精确检验。结果妊娠期和产褥期两组患者对比,除妊娠期患者行CT检查率显著低于产褥期患者(22.73%vs 58.97%,χ^(2)=7.44,P=0.006)以外,其余基线资料两组间均无统计学差异(P值均>0.05)。在ERCP诊疗中,妊娠期患者行胆道取石、经内镜乳头球囊扩张术均显著低于产褥期患者(χ^(2)值分别为4.007、4.315,P值均<0.05),妊娠期患者未使用X线透视的比例高于产褥期患者(χ^(2)=12.103,P=0.001)。两组患者ERCP术后WBC、TBil、DBil、ALT、AST较术前均有显著改善(P值均<0.05)。两组患者ERCP术后总体并发症发生率为7.04%(5/71),以术后胆系感染最为常见,两组患者术后并发症发生率无显著差异(P>0.05)。在分娩和胎儿结局方面,妊娠期患者提前终止妊娠比例高于产褥期患者(50.00%vs 0,χ^(2)=20.528,P<0.001),妊娠期患者的剖宫产率显著低于产褥期患者(36.36%vs76.92%,χ^(2)=4.756,P=0.029)。胎儿异常发育及死胎等不良事件的发生率两组间无显著差异(P>0.05)。结论在严格把握ERCP指征和时机的情况下,无论在妊娠期还是产褥期,行ERCP诊疗是有效和相对安全的,患者ERCP并发症发生率与普通人群相当,且有较好的分娩和胎儿结局。

Objective To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography(ERCP)during pregnancy and puerperium through a comparative analysis.Methods A retrospective analysis was performed for the clinical data of 22 patients in pregnancy and 39 patients in puerperium who received ERCP in Digestive Endoscopy Center of The First Affiliated Hospital of Nanchang University from January 2007 to August 2022.The two groups of patients were compared in terms of baseline data,diagnosis during ERCP,interventions,laboratory results before and after ERCP,post-ERCP complications,and delivery and fetal outcomes.The independent-samples t test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.Results There were no significant differences between the patients in pregnancy and those in puerperium in all baseline data(all P>0.05)except the rate of CT examination(22.73%vs 58.97%,χ^(2)=7.44,P=0.006).During the ERCP procedure,compared with the patients in puerperium,the patients in pregnancy had a significantly lower proportion of the patients who underwent biliary stone extraction or endoscopic papillary balloon dilation(χ^(2)=4.007 and 4.315,both P<0.05)and a significantly higher proportion of the patients who did not receive X-ray fluoroscopy(χ^(2)=12.103,P=0.001).After ERCP,both groups had significant improvements in white blood cell count,total bilirubin,direct bilirubin,alanine aminotransferase,and aspartate aminotransferase(all P<0.05).The overall incidence rate of post-ERCP complications was 7.04%(5/71)for all patients,with post-ERCP biliary infection as the most common complication(3/71,4.23%),and there was no significant difference in the incidence rate of post-ERCP complications between the two groups(P>0.05).As for delivery and fetal outcomes,compared with the patients in puerperium,the patients in pregnancy had a significantly higher proportion of patients with early termination of pregnancy(50.00%vs 0,χ^(2)=20.528,P<0.001)and a significantly lower proportion of patients with cesarean section(36.36%vs 76.92%,χ^(2)=4.756,P=0.029).There were no significant differences in the incidence rates of adverse events such as abnormal fetal development and stillbirth between the two groups(P>0.05).Conclusion With strict control of ERCP indications and timing,ERCP is effective and relatively safe in both pregnancy and puerperium and has a comparable incidence rate of post-ERCP complications to that in the general population,with relatively good delivery and fetal outcomes.