ERCP术后发生急性胰腺炎的危险因素分析

摘要

Objective To analyze the risk factors of acute pancreatitis after endoscopic retrograde cholangio pancreatography (ERCP). Method The clinical data of 160 patients with diagnostic (or therapeutic) ERCP in Beijing Friendship Hospital from September 2014 to February 2016 were retrospective analyzed. The patients' age, sex, body weight, hospitalization time, past history, the results of preoperative liver biochemical examination, hematuria amylase, coagulation function and magnetic resonance cholangiopancreatography (MRCP), intraoperative pancreatic ducts, and intraoperative diagnosis, postoperative blood amylase and abdominal pain were recorded respectively. Univariate and multivariate logistic regression analysis were performed on the above datas. Result Acute pancreatitis after ERCP was performed in 18 out of 160 patients. The incidence rate was 11.25%. Univariate logistic regression showed that age, sex, number of intubations, presence of pancreatic ducts, visualization of pancreatic ducts, number of injections of contrast agents, and presence or absence of nasal bile duct drainage correlated with the occurrence of acute pancreatitis after ERCP. Multivariate Logistic regression analysis showed that female, intubation frequency≥3 times, pancreatic duct imaging were independent risk factors of acute pancreatitis after ERCP (P<0.05). Nasobiliary drainage was a protective factor for acute pancreatitis after ERCP surgery (P<0.05). Conclusion In order to avoid the occurrence of acute pancreatitis after ERCP, the female patients treated with ERCP should be evaluated before the operation, and the postoperative monitoring should be strengthened;the number of intubations should be minimize; and the nasal bile duct drainage should be used for diagnosis and treatment.%目的 分析内镜逆行胰胆管造影术(endoscopic retrograde cholangio pancreatography,ERCP)术后急性胰腺炎发生的危险因素.方法 回顾性分析2014年9月至2016年2月于本院行诊断性或治疗性ERCP的160例患者的临床资料,分别记录患者的年龄、性别、体重、住院天数及既往史等一般资料,术前肝脏生化检查、血/尿淀粉酶、凝血功能及磁共振胰胆管造影(magnetic resonance cholangiopancreatography,MRCP)结果,术中胰管是否显影及术中诊断情况,术后血淀粉酶及腹痛情况.对上述资料行单因素和多因素Logistic回归分析.结果 160例患者中有18例发生了ERCP术后急性胰腺炎,发生率为11.25%.单因素分析结果显示,年龄、性别、插管次数、有无胰管插管、胰管是否显影、注射造影剂次数及有无鼻胆管引流与ERCP术后急性胰腺炎的发生存在相关性.多因素分析显示,女性、插管次数≥3次、胰管显影是ERCP术后发生急性胰腺炎的独立危险因素(P<0.05),鼻胆管引流是ERCP术后发生急性胰腺炎的保护因素(P<0.05).结论 为避免ERCP术后急性胰腺炎的发生,临床医师应对采用ERCP诊治的女性患者做好术前评估,加强术后监控;提高操作技能,尽可能减少插管次数;同时,采用鼻胆管引流的方式进行诊治.