摘要
目的探讨内镜下逆行性胰胆管造影术(ERCP)后引起急性胰腺炎(PEP)的危险因素。方法收集武汉大学中南医院2016年1月至2017年8月消化内科住院行ERCP治疗的1 041例患者的临床特征、手术操作、术后消化道表现及实验室指标。依患者术后临床表现及淀粉酶、脂肪酶、腹部影像学等指标将患者分为术后发生PEP组和未发生PEP组,采用SPSS 22.0进行t检验、U检验、χ^2检验和秩和检验比较两组的临床特征及实验室数据,用logistic回归分析PEP的危险因素。结果PEP组患者53例,未发生PEP组988例,PEP总体发生率5.09%。两组术后白细胞计数[8.56(5.43,12.23)×10^9/L比7.12(5.58,9.20)×10^9/L,Z=-2.122]、中性粒细胞比值(0.82±0.11比0.76±0.12,t=-3.612)、术中乳头括约肌切开[60.37%(32/53)比43.72%(432/988),χ^2=5.646]、胆管球囊扩张[50.94%(27/53)比33.00%(326/988),χ^2=7.230]及乳头旁憩室[35.85%(19/53)比52.98%(523/988),χ^2=4.619]发生率比较,差异有统计学意义(均P<0.05)。logistic回归分析提示术后中性粒细胞比值是发生PEP的独立危险因素(OR=1.058,95%CI:1.019~1.098,P=0.003)。结论术后白细胞数、中性粒细胞比值、术中乳头括约肌切开、胆管球囊扩张及乳头旁憩室与PEP发生相关,其中术后中性粒细胞比值是其独立危险因素。
Objective To investigate the risk factors of acute pancreatitis after endoscopic retrograde chloangiopancreatography (ERCP). Methods Clinical date of 1 041 patients who underwent therapeutic ERCP from January 2016 to August 2017 in department of gastroenterology, Zhongnan Hospital of Wuhan University, were retrospectively studied. Among them post-ERCP pancreatitis developed in 53 patients (PEP group) and the remaining 988 patients were assigned in the non-PEP group. The clinical characteristics, procedures of ERCP, gastrointestinal symptoms and laboratory findings after ERCP were compared between two groups. The SPSS software (version 22.0) was applied to analyze the risk factors of PEP. Results The overall incidence rate of PEP was 5.09%(53/1 041). There were statistic difference in the number of white cells [8.56 (5.43, 12.23)×10^9/L vs. 7.12 (5.58, 9.20)×10^9/L, Z=-2.122] and the ratio of neutrophils [0.82±0.11 vs. 0.76±0.12, t=-3.612] after ERCP operation;the incidence of endoscopic sphincterotomy (EST)[60.37%(32/53) vs. 43.72%(432/988),χ^2=5.646] and endoscopic papillary balloon dilation (EPBD)[50.94%(27/53) vs. 33.00%(326/988),χ^2=7.230] during operation, and periampullary diverticula [35.85%(19/53) vs. 52.98%(523/988),χ^2=4.619](all P<0.05). Logistic analysis indicated that the ratio of neutrophils was independent risk factor of PEP (OR=1.058, 95%CI: 1.019-1.098, P=0.003). Conclusion The number of white cells, the ratio of neutrophils after ERCP and endoscopic sphincterotomy, endoscopic papillary balloon dilation and periampullary diverticula are associated with PEP, while the ratio of neutrophils is the independent risk factor of PEP.
作者
陈文华
林军
王红玲
王剑屏
杨晟
胡腾腾
赵秋
Chen Wenhua;Lin Jun;Wang Hongling;Wang Jianping;Yang Sheng;Hu Tengteng;Zhao Qiu(Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Department of Gastroenterology/Hepatology, Zhongnan Hospital of Wuhan University, the Hubei Clinical Center & Key Laboratory of Intestinal & Colorectal Diseases, Wuhan 430000, China)
出处
《中华全科医师杂志》
2019年第3期256-260,共5页
Chinese Journal of General Practitioners
关键词
胰胆管造影术
内窥镜逆行
胰腺炎
危险因素
Cholangiopancreatography, endoscopic retrograde
Pancreatitis
Risk factors
