ERCP乳头切开取石术后胰腺炎影响因素分析

【作者】 刘鸿飞；

【导师】 樊艳华；

【作者基本信息】 北京中医药大学 ， 中西医结合临床， 2012， 硕士

【摘要】 研究背景：自从ERCP技术广泛应用于临床至今已有50余年,对于ERCP术后并发症的研究重点也逐渐从治疗转为预防,因此对于影响ERCP术后胰腺炎发生的危险因素的探讨也越来越深入。既往研究表明,患者本身的因素和操作因素共同影响ERCP术后胰腺炎的发生。目的：本研究的目的是探讨我中心2003-2011年间因胆总管结石行ERCP乳头切开取石术患者发生ERCP术后胰腺炎(PEP)的影响因素。方法：搜集我中心2003-2011年398例胆总管结石行ERCP乳头切开取石术患者,对于他们的一般资料和ERCP相关资料进行系统的整理,根据纳入和排除标准,我们仅选取首次行ERCP乳头切开取石术的符合上述纳入标准的胆总管结石患者进入研究,对符合标准并纳入研究的327例病例的资料进行数据分析。数据分析运用SPSS17.0统计软件。我们将所有纳入的患者分为胰腺炎组和非胰腺炎组,将搜集的患者信息分为基线资料和ERCP相关资料两类。运用X2和t检验进行单因素分析,将得出的有意义的因素带入二元非线性回归进行多因素分析,从而得出影响ERCP术后胰腺炎发生的独立因素。其中,ERCP术后并发症的定义参照《内镜逆行胰胆管造影》第六章(ERCP并发症的预测、预防和治疗》中关于ERCP主要并发症的共识定义。胆总管扩张程度分级根据我中心ERCP操作经验进行,具体如下：胆总管直径d<1.0cm为正常,1cm<d≤1.5cm为轻度扩张,1.5cm<d<2cm为中度扩张,d>2cm为重度扩张。结果：1、在搜集整理的398例病例中,共327例病例符合标准并纳入统计学分析,其中术后并发胰腺炎23例(7.03%),均为轻症,经内科保守治疗后好转,无死亡病例。其余304例病例术后未并发胰腺炎。2、将所有纳入统计学分析的327例病例分为两组：胰腺炎组和非胰腺炎组。单因素分析结果显示ERCP术后胰腺炎的发生与患者既往是否患有胆囊结石、入院时直接胆红素、总胆红素、谷氨酸氨基转肽酶、丙氨酸氨基转肽酶、谷氨酰转肽酶、甘油三酯水平、以及ERCP术中观察到的胆总管扩张程度有关。3、多因素分析结果显示既往胆囊结石病史和胆总管扩张程度为影响PEP发生的独立因素。4、在并发胰腺炎的23例患者中,6例患者ERCP术中发现胆总管无扩张,17例患者ERCP术中观察到胆总管轻度扩张(1cm<d≤1.5cm)。而胆总管中度和重度扩张的患者无一例并发ERCP术后胰腺炎。结论：1、既往有胆囊结石病史、胆总管宽度越趋近于正常的胆总管结石患者,行ERCP乳头切开取石术后并发胰腺炎的可能性越大。2、既往文献中提到的性别、年龄、插管困难等因素在本研究中无明显统计学差异。更多还原

【Abstract】 Background:More than50years have passed since ERCP have been wildly used in clinical practice. More and more study about the complication has been done and now people give more attention to the precaution. According to the previous study, patients-related factors and the procedure-related factors both influence the incidence of PEP. Objective:The goal of this study is to evaluate the influence factors of post-ERCP pancreatitis over398patients in our center.Methods:We collected398cases in which patients received ERCP because of oledocholithiasis from2003to2011and327cases was chosen according to the inclusion and exclusion criteria. To do the data analysis, software SPSS17.0Stat. was used. The327cases was divided into two groups:PEP group and non-PEP group and the information that we collected was divided into two parts:the basic data and the ERCP-related data. We chose the X2test and t test to do the univariate analysis and the logistic regression to do the multiplicity. The definition of the complication of ERCP was made according to the Consensus of the de Complications of ERCP that was mentioned in 《ERCP》，Chapter6.The expansion degree of bile duct was made according to clinical experiences of our center which is normal(d≤1.0cm), mild(1cm<d≤1.5cm), moderate(1.5cm<d≤2cm) and severe(2cm<d).Rrsults:1、The statistical analysis was performed on327patients, on whom the PEP was occurred, of the398patients.23(7.03%) patients who had the complications all suffered mild pancreatitis, and are all cured by conservative treatments and there was no death.2. All the cases was divided into two groups, the PEP group and the non-PEP group. The result of univariate analysis shows that the occurance of PEP was related with the medical history of cholecystolithiasis、TBIL、DBIL、ALT、AST、GGT、TG and the standard of oledochectasia.3、Multiplicity shows that only the medical history of cholecystolithiasis and the standard of oledochectasia are related.4.6of the patients who had PEP have normal bile duct and the other17patients have mild-expansive bile duct. None of the patients who have moderate or severe expansive bile duct suffer PEP.Conclusion:1、The patient who has the medical history of cholecystolithiasis and a more normal choledoch has the lower risk of PEP.2、 Other risk factors such as sex、age、and operating related factors shows no statistical difference in our study.更多还原