术前超声内镜检查对胆胰疾病患者行内镜逆行胰胆管造影术的影响

Effect of preoperative endoscopic ultrasonography on endoscopic retrograde cholangiopancreatography in patients with biliary and pancreatic diseases

摘要:

目的 探讨术前超声内镜（EUS）检查对胆胰疾病患者行内镜逆行胰胆管造影（ERCP）的影响，并评估其必要性。方法 收集2017年2月－2020年4月在南方医科大学附属深圳宝安医院住院行ERCP患者的临床资料。病例组在ERCP术前2 h内完成EUS检查后行ERCP（EUS+ERCP组，n = 166），对照组单纯行ERCP（单纯ERCP组，n = 166）。再以ERCP操作难度等级进一步分成简单操作和复杂操作两个亚组。对比分析ERCP插管成功率、操作时间、术后并发症发生率和辐射暴露等。结果 两组患者年龄、性别、ERCP适应证、住院天数、ERCP插管成功率和术后并发症发生率比较，差异均无统计学意义（P > 0.05）。EUS+ERCP组操作时间短于单纯ERCP组［（36.3±22.5）和（43.8±24.1）min，P < 0.05］。两组简单操作的操作时间比较，差异有统计学意义（P < 0.05），但两组复杂操作的操作时间比较，差异无统计学意义（P > 0.05）。EUS+ERCP组的X线透视时间短于单纯ERCP组［（39.7±27.6）和（49.9±33.5）s，P < 0.05］。按亚组分析，EUS+ERCP组中简单操作和复杂操作的透视时间均短于单纯ERCP组（P < 0.05）。EUS + ERCP组总辐射剂量为（10.3±7.3）mGy，单纯ERCP组为（13.9±10.3）mGy，两组比较，差异有统计学意义（P < 0.05）。两组简单操作和复杂操作的辐射剂量比较，差异均有统计学意义（P < 0.05）。结论 ERCP术前行EUS检查不会改变术后并发症发生率，但可减少ERCP操作时间，尤其是对于低操作难度的ERCP，可同时减少ERCP期间的辐射暴露。

Abstract:

Objective To investigate the effect of endoscopic ultrasonography (EUS) before endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliary and pancreatic diseases, and evaluate its necessity.Methods Clinical data of patients with ERCP from February 2017 to April 2020 were collected. EUS was performed within 2 h before ERCP and then ERCP was performed in the case group (EUS + ERCP group, n = 166), while ERCP was performed in the control group (ERCP group, n = 166). According to the difficulty level of ERCP operation, it is further divided into two subgroups: simple operation group and complex operation group. The intubation success rate of ERCP, operation time, incidence of postoperative complications and radiation exposure were compared and analyzed.Results There was no significant difference in age, sex, ERCP indication, hospitalization days, intubation success rate of ERCP and the incidence of postoperative complications between the two groups. The operation time in EUS + ERCP group was shorter than that in ERCP group [(36.3 ± 22.5) min vs (43.8 ± 24.1) min, P < 0.05]. There was significant difference in the operation time of the simple operation group (P < 0.05), but there was no significant difference in the operation time of the complex operation group (P > 0.05). The time of X-ray fluoroscopy in EUS + ERCP group was shorter than that in ERCP group [ (39.7 ± 27.6) s vs (49.9 ± 33.5) s, P < 0.05]. According to the subgroup analysis, the fluoroscopy time of the simple operation group and the complex operation group in the EUS + ERCP group was shorter than that in the ERCP group (P < 0.05). The total radiation dose of EUS + ERCP group was (10.3 ± 7.3) mGy, and that of ERCP group was (13.9 ± 10.3) mGy, the difference was statistically significant (P < 0.05). There were significant differences in radiation dose between simple operation group and complex operation group (P < 0.05).Conclusion EUS before ERCP will not change the incidence of complications after ERCP, but it can reduce the operation time of ERCP, especially ERCP with low difficulty level. And the use of EUS reduces radiation exposure during ERCP.