ERCP术后胰腺炎的危险因素分析及预防

发布时间：2018-02-26 14:16

本文关键词： 逆行性胰胆管造影并发症胰腺炎危险因素　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:本文通过分析经内镜逆行胰胆管造影术后胰腺炎(Post-ERCP pancreatitis,PEP)的相关危险因素,结合相关文献及相应的临床经验,探讨预防措施,旨在提高经内镜逆行胰胆管造影的(Endoscopic retrograde cholangiopancreatography,ERCP)的诊断及治疗水平,减少术后胰腺炎的发病率。方法:本文回顾性分析了2011年1月至2015年12月间在大连医科大学附属第二医院行ERCP诊断及治疗的222例临床资料,按一定的入选和排除标准,收集分析患者基本信息(包括性别、年龄、基础疾病、既往手术史等)、术前实验室检查(包括肝生化、血常规、淀粉酶等)以及术前辅助检查(包括CT、磁共振胰胆管成像(Magnetic Resonance Cholangiopancreatography,MRCP))等检查结果,记录ERCP术中操作及术中诊断,记录患者行ERCP后血淀粉酶水平,结合腹部体征判断有无胰腺炎的发生。首先对性别、年龄、胆总管直径、是否胰管显影等20个因素进行单因素分析,分析其对术后胰腺炎的影响。然后对单因素中有统计学意义的因素再进行多因素Logistic回归分析,进一步明确ERCP术后胰腺炎的独立危险因素。所有数据均采用SPSS17.0统计软件进行数据处理。结果:通过回顾性分析进行ERCP检查的222例病例,其中成功216例,失败6例,ERCP的成功率为97.30%。其中诊断性ERCP8例,治疗性ERCP214例。ERCP的病种分类:胆管结石120例,良性狭窄43例,恶性肿瘤24例,单纯胆管扩张17例,硬化性胆管炎5例,化脓性胆管炎4例,Oddi括约肌功能障碍(Sphincter of oddi dysfunction,SOD)3例,壶腹部占位不除外2例,主胰管扩张2例,正常2例。男性123例,女性99例,平均年龄63.59±16.25岁。222例临床病例中有18例符合ERCP术后胰腺炎诊断标准,ERCP术后胰腺炎的发生率为8.11%。单因素分析的结果显示:年龄小于60岁患者组ERCP术后胰腺炎发生率高于年龄大于60岁组(13.92%vs4.90%,P=0.018)。困难插管患者组ERCP术后胰腺炎发生率高于非困难插管患者组(19.51%vs5.52%,P=0.003)。术长时间大于60分钟患者组ERCP术后胰腺炎发生率高于术长时间小于60分钟患者(17.65%vs6.38%,P=0.027)。胰管显影患者组ERCP术后胰腺炎发病率高于非胰管显影(50%vs6.54%,P0.001)。未放置鼻胆引流管患者组ERCP术后胰腺炎发生率高于放置鼻胆引流管患者组(17.5%vs2.82%,P0.001),以上五个因素与ERCP术后胰腺炎的发生有关(P0.05),其他因素则未见明显相关性。将以上五个相关因素纳入Logistic回归方程进行多因素分析,分析得出胰管显影及年龄小于60岁是ERCP术后胰腺炎的独立危险因素。鼻胆管引流是ERCP术后胰腺炎的保护因素。结论:1.ERCP术后胰腺炎的发生与年龄小于60岁、胰管显影、困难插管、术长时间过长相关。其中胰管显影及年龄小于60岁是ERCP术后胰腺炎发生的独立危险因素。2.术后放置鼻胆引流管、避免胰管显影、提高插管成功率、降低ERCP操作时间等方法可有效降低ERCP术后胰腺炎的发生。
[Abstract]:Objective: to analyze the risk factors associated with post-ERCP pancreatitis (PEP) after endoscopic retrograde cholangiopancreatography (ERCP), and to explore the preventive measures in combination with relevant literature and clinical experience. To improve the diagnosis and treatment of Endoscopic retrograde cholangiopancreatography (ERCP) by endoscopic retrograde cholangiopancreatography (ERCP). Methods: the clinical data of 222 cases of ERCP diagnosis and treatment in the second affiliated Hospital of Dalian Medical University from January 2011 to December 2015 were analyzed retrospectively. To collect and analyze the basic information of the patients (including sex, age, basic diseases, previous surgical history, etc.), and the laboratory examination before operation (including liver biochemistry, blood routine examination, etc.). The results of preoperative auxiliary examination (including CTT, magnetic Resonance cholangiopancreatography), and the intraoperative operation and diagnosis of ERCP were recorded, and the serum amylase levels after ERCP were recorded. Combined with abdominal signs to determine the occurrence of pancreatitis. First of all, 20 factors, such as gender, age, common bile duct diameter, pancreatic duct development and so on, were analyzed by single factor analysis. The influence on postoperative pancreatitis was analyzed, and then multivariate Logistic regression analysis was performed on the single factor with statistical significance. The independent risk factors of pancreatitis after ERCP were further determined. All the data were processed by SPSS17.0 software. Results: among the 222 cases examined by ERCP retrospectively, 216 cases were successful. The success rate was 97.30% in 6 cases of failure, including diagnostic ERCP8 and therapeutic ERCP214. The classification of the disease was as follows: cholelithiasis in 120 cases, benign stenosis in 43 cases, malignant tumor in 24 cases, simple dilatation of bile duct in 17 cases, sclerosing cholangitis in 5 cases. There were 4 cases of suppurative cholangitis with sphincter of oddi dysfunction, 3 cases with sphincter of oddi dysfunction, 2 cases with ampullary space occupation, 2 cases with dilatation of the main pancreatic duct, 2 cases with normal pancreatic duct, 123 cases with male and 99 cases with female. The average age was 63.59 卤16.25 years old. 222 clinical cases, 18 cases met the diagnostic criteria of ERCP postoperative pancreatitis, the incidence of post-ERCP pancreatitis was 8.11.The results of univariate analysis showed that the incidence of postoperative pancreatitis in patients younger than 60 years old was high. The incidence of pancreatitis after ERCP in patients with difficult intubation was higher than that in patients without difficult intubation (19.51 vs 5.52P 0.003). The incidence of postoperative pancreatitis in patients with long duration of operation more than 60 minutes was higher than that in patients with long duration of operation less than 60 minutes. The incidence of pancreatitis after ERCP in the pancreatic duct development group was higher than that in the non-pancreatic duct development group. The incidence of postoperative pancreatitis in the patients without nasobiliary drainage tube was higher than that in the patients without nasobiliary drainage tube, and the incidence of pancreatitis in the patients without nasobiliary drainage tube was higher than that in the patients with nasobiliary drainage tube placement. The incidence of inflammation was related to P0.05, but no significant correlation was found among the other factors. The above five factors were included in the Logistic regression equation for multivariate analysis. It was concluded that the development of pancreatic duct and age less than 60 years were independent risk factors of pancreatitis after ERCP, and the nasobiliary drainage was the protective factor of pancreatitis after ERCP. Conclusion 1. The incidence and age of pancreatitis after ERCP are less than 60 years, pancreatic duct development and difficult intubation. The development of pancreatic duct and age less than 60 years were the independent risk factors of pancreatitis after ERCP. 2. After operation, nasobiliary drainage tube was placed to avoid pancreatic duct development and improve the success rate of intubation. Reducing the operation time of ERCP can effectively reduce the incidence of pancreatitis after ERCP.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R576

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