ERCP术后胰腺炎危险因素分析及其预防

发布时间：2018-06-05 21:59

本文选题：ERCP + PEP　；参考：《山西医科大学》2014年硕士论文

【摘要】：目的探讨ERCP术后并发胰腺炎的危险因素，并在研究结果基础上结合文献资料，提出ERCP术后胰腺炎的有效预防措施。方法收集2010年10月至2013年7月于山西医科大学第一附属医院住院行ERCP检查或治疗的168例患者的住院资料。按一定入选和排除标准筛选资料，对符合标准的病例先采用单因素分析方法分别分析患者性别、年龄、肥胖、黄疸、麻醉方式、插管次数、胰管显影次数、乳头括约肌功能障碍（SOD）、乳头括约肌切开（EST）、鼻胆管引流（ENBD）、胆管支架置入等因素与ERCP术后并发胰腺炎的关系。对单因素分析结果中有统计学意义的因素进行多因素非条件Logistic回归分析，进一步筛选出ERCP术后胰腺炎的独立危险因素。结果收集到的168例患者中有153例符合入选标准，不符合排除标准。153例患者中发生ERCP术后胰腺炎患者有19例，胰腺炎发生率为12.42%。单因素分析结果显示在所选择的25个因素中有9个因素有统计学意义，分别为性别（女性）、年龄（＜60岁）、胰腺炎史、乳头括约肌功能障碍（SOD）、插管次数（≥3）、胰管插管、胰管显影、注射造影剂次数（＞2）、鼻胆管引流。将有统计意义因素行多因素非条件Logistic回归分析，最终筛选出4个变量，其中女性（OR：4.240，95%CI：0.797-22.545）、乳头括约肌功能障碍（OR：5.715，95%CI：0.988-33.052）、多次插管为（OR：8.540，，95%CI：1.746-41.761）ERCP术后胰腺炎的独立危险因素，而鼻胆管引流（OR：0.234，95%CI：0.058-0.947）为ERCP术后胰腺炎的保护因素。ERCP术后胰腺炎的预防包括患者的选择，内镜技术和药物预防，严格掌握ERCP适应症与禁忌症，术前对患者进行风险评估，术中操作轻柔仔细，必要时请上级专家指导，术后留置鼻胆管引流，预防性应用生长抑素、奥曲肽、抗生素等药物可有效预防ERCP术后胰腺炎的发生。结论女性、乳头括约肌功能障碍、多次插管是ERCP术后胰腺炎的高危因素，而鼻胆管引流可预防ERCP术后胰腺炎的发生。严格掌握ERCP适应症与禁忌症，必要时留置鼻胆管引流以及预防性应用生长抑素等药物可有效预防ERCP术后胰腺炎的发生。
[Abstract]:Objective to explore the risk factors of pancreatitis after ERCP and to provide effective preventive measures for pancreatitis after ERCP.
Methods the data of 168 patients who were hospitalized at the First Affiliated Hospital of Shanxi Medical University from October 2010 to July 2013 were collected from 168 patients who were examined or treated. According to the selected and excluded criteria, a single factor analysis was used to analyze the sex, age, obesity, jaundice, anesthesia, intubation and intubation. The number of times, the number of pancreatic duct development, the sphincter sphincter dysfunction (SOD), the sphincter sphincter (EST), the nasal bile duct drainage (ENBD), the stent placement of the bile duct and other factors associated with pancreatitis after ERCP. The multivariate non conditional Logistic regression analysis was carried out on the statistical factors of the single factor analysis, and the ERCP operation was further screened. Independent risk factors for post pancreatitis.
Results of the 168 patients, 153 of the 168 patients met the criteria for admission. There were 19 cases of post ERCP pancreatitis in the patients who did not meet the exclusion criteria. The incidence of pancreatitis was 12.42%. single factor analysis. The results showed that 9 of the 25 factors selected were statistically significant, namely, sex (female), age (60 years old), and pancreas The history of mastitis, sphincter dysfunction (SOD), intubation times (> 3), pancreatic duct intubation, pancreatic duct development, injection of contrast media (> 2), and naso bile duct drainage. The statistical significance factors were analyzed by multiple factors unconditional Logistic regression analysis, and 4 variables were selected, in which women (OR:4.240,95%CI:0.797-22.545) and sphincter dysfunction (O R:5.715,95%CI:0.988-33.052) independent risk factors for pancreatitis after multiple intubation (OR:8.540,95%CI:1.746-41.761) ERCP, and nasal bile duct drainage (OR:0.234,95%CI:0.058-0.947) as a protective factor for post ERCP pancreatitis, the prevention of post operation pancreatitis after ERCP includes patient selection, endoscopic technique and drug prevention, and strict control ERCP indications and contraindications, risk assessment of patients before operation, soft and careful operation during operation, guidance from superior experts when necessary, postoperative retention of nasal bile duct drainage, preventive application of somatostatin, octreotide, antibiotics and other drugs can effectively prevent the onset of post ERCP pancreatitis.
Conclusion female, papillary sphincter dysfunction and multiple intubation are the high risk factors for post ERCP pancreatitis, and nasbd drainage can prevent the occurrence of post ERCP pancreatitis. Strict control of ERCP indications and contraindications, the necessary indwelling nasobiliary drainage and preventive application of growth suppressor can effectively prevent the onset of post ERCP pancreatitis. Birth.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R576

【参考文献】