發(fā)布時(shí)間：2018-02-26 14:16

  本文關(guān)鍵詞： 逆行性胰膽管造影 并發(fā)癥 胰腺炎 危險(xiǎn)因素　出處：《大連醫(yī)科大學(xué)》2016年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:本文通過(guò)分析經(jīng)內(nèi)鏡逆行胰膽管造影術(shù)后胰腺炎(Post-ERCP pancreatitis,PEP)的相關(guān)危險(xiǎn)因素,結(jié)合相關(guān)文獻(xiàn)及相應(yīng)的臨床經(jīng)驗(yàn),探討預(yù)防措施,旨在提高經(jīng)內(nèi)鏡逆行胰膽管造影的(Endoscopic retrograde cholangiopancreatography,ERCP)的診斷及治療水平,減少術(shù)后胰腺炎的發(fā)病率。方法:本文回顧性分析了2011年1月至2015年12月間在大連醫(yī)科大學(xué)附屬第二醫(yī)院行ERCP診斷及治療的222例臨床資料,按一定的入選和排除標(biāo)準(zhǔn),收集分析患者基本信息(包括性別、年齡、基礎(chǔ)疾病、既往手術(shù)史等)、術(shù)前實(shí)驗(yàn)室檢查(包括肝生化、血常規(guī)、淀粉酶等)以及術(shù)前輔助檢查(包括CT、磁共振胰膽管成像(Magnetic Resonance Cholangiopancreatography,MRCP))等檢查結(jié)果,記錄ERCP術(shù)中操作及術(shù)中診斷,記錄患者行ERCP后血淀粉酶水平,結(jié)合腹部體征判斷有無(wú)胰腺炎的發(fā)生。首先對(duì)性別、年齡、膽總管直徑、是否胰管顯影等20個(gè)因素進(jìn)行單因素分析,分析其對(duì)術(shù)后胰腺炎的影響。然后對(duì)單因素中有統(tǒng)計(jì)學(xué)意義的因素再進(jìn)行多因素Logistic回歸分析,進(jìn)一步明確ERCP術(shù)后胰腺炎的獨(dú)立危險(xiǎn)因素。所有數(shù)據(jù)均采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)處理。結(jié)果:通過(guò)回顧性分析進(jìn)行ERCP檢查的222例病例,其中成功216例,失敗6例,ERCP的成功率為97.30%。其中診斷性ERCP8例,治療性ERCP214例。ERCP的病種分類(lèi):膽管結(jié)石120例,良性狹窄43例,惡性腫瘤24例,單純膽管擴(kuò)張17例,硬化性膽管炎5例,化膿性膽管炎4例,Oddi括約肌功能障礙(Sphincter of oddi dysfunction,SOD)3例,壺腹部占位不除外2例,主胰管擴(kuò)張2例,正常2例。男性123例,女性99例,平均年齡63.59±16.25歲。222例臨床病例中有18例符合ERCP術(shù)后胰腺炎診斷標(biāo)準(zhǔn),ERCP術(shù)后胰腺炎的發(fā)生率為8.11%。單因素分析的結(jié)果顯示:年齡小于60歲患者組ERCP術(shù)后胰腺炎發(fā)生率高于年齡大于60歲組(13.92%vs4.90%,P=0.018)。困難插管患者組ERCP術(shù)后胰腺炎發(fā)生率高于非困難插管患者組(19.51%vs5.52%,P=0.003)。術(shù)長(zhǎng)時(shí)間大于60分鐘患者組ERCP術(shù)后胰腺炎發(fā)生率高于術(shù)長(zhǎng)時(shí)間小于60分鐘患者(17.65%vs6.38%,P=0.027)。胰管顯影患者組ERCP術(shù)后胰腺炎發(fā)病率高于非胰管顯影(50%vs6.54%,P0.001)。未放置鼻膽引流管患者組ERCP術(shù)后胰腺炎發(fā)生率高于放置鼻膽引流管患者組(17.5%vs2.82%,P0.001),以上五個(gè)因素與ERCP術(shù)后胰腺炎的發(fā)生有關(guān)(P0.05),其他因素則未見(jiàn)明顯相關(guān)性。將以上五個(gè)相關(guān)因素納入Logistic回歸方程進(jìn)行多因素分析,分析得出胰管顯影及年齡小于60歲是ERCP術(shù)后胰腺炎的獨(dú)立危險(xiǎn)因素。鼻膽管引流是ERCP術(shù)后胰腺炎的保護(hù)因素。結(jié)論:1.ERCP術(shù)后胰腺炎的發(fā)生與年齡小于60歲、胰管顯影、困難插管、術(shù)長(zhǎng)時(shí)間過(guò)長(zhǎng)相關(guān)。其中胰管顯影及年齡小于60歲是ERCP術(shù)后胰腺炎發(fā)生的獨(dú)立危險(xiǎn)因素。2.術(shù)后放置鼻膽引流管、避免胰管顯影、提高插管成功率、降低ERCP操作時(shí)間等方法可有效降低ERCP術(shù)后胰腺炎的發(fā)生。
[Abstract]:Objective: to analyze the risk factors associated with post-ERCP pancreatitis (PEP) after endoscopic retrograde cholangiopancreatography (ERCP), and to explore the preventive measures in combination with relevant literature and clinical experience. To improve the diagnosis and treatment of Endoscopic retrograde cholangiopancreatography (ERCP) by endoscopic retrograde cholangiopancreatography (ERCP). Methods: the clinical data of 222 cases of ERCP diagnosis and treatment in the second affiliated Hospital of Dalian Medical University from January 2011 to December 2015 were analyzed retrospectively. To collect and analyze the basic information of the patients (including sex, age, basic diseases, previous surgical history, etc.), and the laboratory examination before operation (including liver biochemistry, blood routine examination, etc.). The results of preoperative auxiliary examination (including CTT, magnetic Resonance cholangiopancreatography), and the intraoperative operation and diagnosis of ERCP were recorded, and the serum amylase levels after ERCP were recorded. Combined with abdominal signs to determine the occurrence of pancreatitis. First of all, 20 factors, such as gender, age, common bile duct diameter, pancreatic duct development and so on, were analyzed by single factor analysis. The influence on postoperative pancreatitis was analyzed, and then multivariate Logistic regression analysis was performed on the single factor with statistical significance. The independent risk factors of pancreatitis after ERCP were further determined. All the data were processed by SPSS17.0 software. Results: among the 222 cases examined by ERCP retrospectively, 216 cases were successful. The success rate was 97.30% in 6 cases of failure, including diagnostic ERCP8 and therapeutic ERCP214. The classification of the disease was as follows: cholelithiasis in 120 cases, benign stenosis in 43 cases, malignant tumor in 24 cases, simple dilatation of bile duct in 17 cases, sclerosing cholangitis in 5 cases. There were 4 cases of suppurative cholangitis with sphincter of oddi dysfunction, 3 cases with sphincter of oddi dysfunction, 2 cases with ampullary space occupation, 2 cases with dilatation of the main pancreatic duct, 2 cases with normal pancreatic duct, 123 cases with male and 99 cases with female. The average age was 63.59 鹵16.25 years old. 222 clinical cases, 18 cases met the diagnostic criteria of ERCP postoperative pancreatitis, the incidence of post-ERCP pancreatitis was 8.11.The results of univariate analysis showed that the incidence of postoperative pancreatitis in patients younger than 60 years old was high. The incidence of pancreatitis after ERCP in patients with difficult intubation was higher than that in patients without difficult intubation (19.51 vs 5.52P 0.003). The incidence of postoperative pancreatitis in patients with long duration of operation more than 60 minutes was higher than that in patients with long duration of operation less than 60 minutes. The incidence of pancreatitis after ERCP in the pancreatic duct development group was higher than that in the non-pancreatic duct development group. The incidence of postoperative pancreatitis in the patients without nasobiliary drainage tube was higher than that in the patients without nasobiliary drainage tube, and the incidence of pancreatitis in the patients without nasobiliary drainage tube was higher than that in the patients with nasobiliary drainage tube placement. The incidence of inflammation was related to P0.05, but no significant correlation was found among the other factors. The above five factors were included in the Logistic regression equation for multivariate analysis. It was concluded that the development of pancreatic duct and age less than 60 years were independent risk factors of pancreatitis after ERCP, and the nasobiliary drainage was the protective factor of pancreatitis after ERCP. Conclusion 1. The incidence and age of pancreatitis after ERCP are less than 60 years, pancreatic duct development and difficult intubation. The development of pancreatic duct and age less than 60 years were the independent risk factors of pancreatitis after ERCP. 2. After operation, nasobiliary drainage tube was placed to avoid pancreatic duct development and improve the success rate of intubation. Reducing the operation time of ERCP can effectively reduce the incidence of pancreatitis after ERCP.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R576

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