治疗性内镜逆行胰胆管造影术后并发胆道出血的客观危险因素分析*

Risk factors of hemobilia after treatment by endoscopic retrograde cholangiopancreatography*

摘要:

探讨治疗性内镜逆行胰胆管造影术（ERCP）后并发胆道出血的客观危险因素。方法 回顾性分析该院收治的285例患者术后行治疗性ERCP的临床资料。根据术后是否出现胆道出血，分为出血组和非出血组，并对发生胆道出血的客观危险因素进行分析。结果 285例患者中共23例患者出现ERCP术后胆道出血，发生率为8.07%。出血组患者胆管癌、壶腹部癌及胰头癌所占比例明显高于非出血组（P <0.05）。出血组患者合并胆道感染及十二指肠乳头憩室，发生率明显高于非出血组（P <0.05）。亚组分析显示，出血组与非出血组相比，结石直径≥2?cm、结石嵌顿和十二指肠乳头内憩室所占比例均明显升高（P <0.05）。 结论 胆道出血是治疗性ERCP术后常见并发症，恶性胆胰肿瘤、胆总管结石直径≥2?cm、结石嵌顿和十二指肠乳头内憩室均是术后胆道出血的危险因素，针对上述因素加强围手术期管理可降低术后胆道出血风险。 关键词：?内镜逆行胰胆管造影；胆道出血；危险因素

Abstract:

To investigate the risk factors of hemobilia after treatment of endoscopic retrograde cholangiopancreatography. Methods A retrospective analysis was made of the clinical data of 285 patients who were treated by therapeutic ERCP. They were divided into the hemorrhage group and the non-hemorrhage group according to whether the patients suffered hemobilia after treatment of ERCP. And the risk factors of hemobilia were analyzed. Results 23 patients suffered hemobilia in the 285 cases who were treated by ERCP, the incidence rate was 8.07%. The proportion of cholangiocarcinoma, ampullary cancer and pancreatic head cancer in the hemorrhage group was higher than that in the non-hemorrhage group (P < 0.05). The incidence of biliary tract infection and duodenal nipple diverticulum in the hemorrhage group was higher than that in the non-hemorrhage group (P < 0.05). Subgroup analysis showed that patients with stone diameter ≥2?cm, stone incarceration and the duodenal papilla into diverticulum in the hemorrhage group were significantly higher than that in the non-hemorrhage group (P < 0.05). Conclusion Hemobilia is a common complication after therapeutic ERCP. Common malignant biliary and pancreatic cancer, bile duct stone diameter ≥2 cm, stone incarceration and duodenal papilla into diverticulum were risk factors of hemobilia after treatment of ERCP, and the risk of postoperative hemobilia can be reduced by strengthening the perioperative management for it.