肝硬化患者经内镜逆行胰胆管造影治疗的安全性分析

摘要

Objective To evaluate the safety of endoscopic retrograde cholangiopancreatography (ERCP)in patients with cirrhosis.Methods A retrospective analysis was performed on the clinical data of 347 patients who were admitted to Beijing You′an Hospital and received ERCP from January 2010 to November 2013.Patients were divided into three groups:patients without liver diseases (n=258),patients with chro-nic hepatitis (n=40),and patients with cirrhosis (n=49).One-way ANOVA or Kruskal-Wallis H test was performed to compare chan-ges in alanine aminotransferase (ALT),aspartate transaminase (AST),albumin (Alb),total bilirubin (TBil),white blood cells (WBC), percentage of neutrophils (NEUT),and serum amylase between the three groups of patients after ERCP.The incidence rates of complica-tions,including hyperamylasemia,acute pancreatitis,infection,hemorrhage,and perforation,and distribution of disease spectrum diagnosis the changes in liver function and blood amylase after ERCP were analyzed compared between the three groups using chi-square test.Re-sults Patients with cirrhosis had significantly lower levels of serum Alb,ALT,and AST than patients in the other two groups before ERCP (H =3.68,P =0.028;H =14.03,P =0.001,and H =8.00,P =0.018,respectively).After ERCP,the TBil level was signifi-cantly higher in the cirrhosis group than in the other two groups (H =6.69,P =0.035).Compared with the serum levels of AST and TBil before ERCP,44.9% (22/49)of patients with cirrhosis had higher levels of AST and TBil 3 days after ERCP,the incidence of which was the highest among all three groups.The percentage of NEUT 1 day after ERCP in patients with cirrhosis was 73.9%±12.7%,which was simi-lar to that in patients without liver diseases (74.8%±11.0%)and higher than that in patients with chronic hepatitis;the difference between the three groups was statistically significant (H=7.31,P=0.026).Although no significant difference in the percentage of patients who had >80%NEUT 3 days after ERCP was observed between the three groups,the percentage was the highest in the group of patients with cirrhosis (18.4%,9/258).The incidence rate of hyperamylasemia 24 hours after ERCP 24 h was significantly higher in patients with cirrhosis (53.1%)than in patients without liver diseases (31.8%)or with chronic hepatitis (40.0%)(χ2 =8.48,P=0.014).The overall com-plication rates in patients with cirrhosis (18.4%)was significantly higher than that in patients without liver diseases (8.1%)or with chron-ic hepatitis (7.5%)(χ2 =26.73,P<0.001).Conclusion ERCP is a safe and effective therapeutic intervention and well tolerated by patients with cirrhosis.Hyperamylasemia should be closely monitored after ERCP.%目的：探讨肝硬化患者接受经内镜逆行胰胆管造影（ERCP）治疗的安全性。方法回顾性分析2010年1月至2013年11月在北京佑安医院接受ERCP治疗的347例患者的临床资料，将所有患者分为无肝病组（258例）、慢性肝炎组（40例）和肝硬化组（49例）。采用单因素方差分析和Kruskal－Wallis H分析3组患者ERCP术后ALT、AST、白蛋白（Alb）、TBil、白细胞（WBC）、中性粒细胞百分数、血淀粉酶的变化，χ2检验分析ERCP术后高淀粉酶血症、急性胰腺炎、感染、出血和穿孔等并发症发生率和疾病诊断的分布。结果肝硬化组患者术前血清Alb、ALT、AST水平低于无肝病组和慢性肝炎组，差异有统计学意义（F＝3．68，P＝0．028；H＝14．03，P＝0.001和H＝8．00，P＝0．018）。肝硬化组患者术后 TBil 水平高于其他2组，差异有统计学意义（H＝6．69，P＝0.035）。44．9％（22／49）的肝硬化组患者术后3 d的AST和TBil高于术前，在3组中的比例最高。肝硬化组患者术后1 d中性粒细胞百分数为（73．9±12．7）％，与无肝病组（74．8±11．0）％相近，高于慢性肝炎组，3组比较差异有统计学意义（H＝7．31，P＝0.026）。虽然术后3 d中性粒细胞百分数＞80％的患者的比例在3组中差异无统计学意义，但是肝硬化组患者的比例最高，为18.4％（9／258）。肝硬化组、无肝病组和慢性肝炎组ERCP术后24 h高淀粉酶血症的发生率是分别是53．1％、31．8％和40.0％，差异有统计学意义（χ2＝8．48，P＝0.014）；3组患者ERCP术后总并发症的发生率分别为18．4％、8．1％和7．5％，差异有统计学意义（χ2＝26．73，P＜0．001）。结论 ERCP诊治肝硬化患者具有良好的耐受性、安全性和成功率，术后需要警惕高淀粉酶血症。