内镜逆行胰胆管造影术后并发胰腺炎的相关因素分析与对策探讨

Discussion on related factors and countermeasures of postoperative pancreatitis with ERCP

摘要:

目的 探讨内镜逆行胰胆管造影术（ERCP）后并发胰腺炎（PEP）的影响因素。方法 回顾性分析2018年2月－2021年2月该院343例行ERCP患者的临床资料，根据是否发生胰腺炎分为PEP组（n = 51）和非PEP组（n = 292）。采用Logistic回归法分析发生PEP的相关危险因素，并提出预防对策。结果 两组患者在性别、年龄 < 60岁、胆总管结石、胰腺炎病史、Oddi括约肌功能障碍、胰腺显影、行胰管括约肌切开术、行Oddi括约肌测压术、ERCP手术结局、插管困难和导丝多次进胰管等方面比较，差异均有统计学意义（P < 0.05）。Logistic回归分析显示，胆总管结石、胰腺炎病史、Oddi括约肌功能障碍、胰腺显影、行胰管括约肌切开术、行Oddi括约肌测压术、ERCP手术失败、插管困难及导丝多次进胰管是PEP的独立危险因素（P < 0.05）。结论 胆总管结石、胰腺炎病史、Oddi括约肌功能障碍、胰腺显影、行胰管括约肌切开术、行Oddi括约肌测压术、ERCP手术失败、插管困难及导丝多次进胰管是PEP的独立危险因素。

Abstract:

Objective To study the influencing factors of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).Methods The clinical data of 343 patients who underwent ERCP from February 2018 to February 2021 were retrospectively analyzed. And divided into PEP group (n = 51) and non-PEP group (n = 292) according to the occurrence of pancreatitis. The related factors for the occurrence of PEP were analyzed, and Logistic regression method was used to analyze the risk factors, and preventive countermeasures were proposed for the risk factors.Results There were statistically significant differences between the two groups in gender, age < 60 years, history of common bile duct stones, pancreatitis, Oddi sphincter dysfunction, pancreatic development, pancreatic duct sphincterotomy, sphincterometry of Oddi, ERCP outcome, difficulty in intubation and multiple insertion of the guide wire into the pancreatic duct (P < 0.05). By Logistic regression analysis showed that choledocholithiasis, history of pancreatitis, Oddi sphincter dysfunction, pancreas development, pancreatic duct sphincterotomy, Oddi sphincter pressure, ERCP failure, difficult intubation and multiple insertion of the guide wire into the pancreatic duct were indeperdent risk facteros of PEP (P < 0.05).Conclusion Choledocholithiasis, history of pancreatitis, Oddi sphincter dysfunction, pancreatic development, pancreatic duct sphincterotomy, Oddi sphincter manometry, ERCP failure, difficulty in intubation and multiple insertion of the guide wire into the pancreatic duct were independent risk factors of PEP.