摘要
目的分析首都医科大学附属北京友谊医院内镜逆行胰胆管造影术(ERCP)操作失败的原因,并着重关注首次ERCP失败后不同补救治疗方式的有效性及复发情况,为ERCP失败后的治疗策略提供参考。方法收集首都医科大学附属北京友谊医院2020年6月1日至2022年9月1日行ERCP患者的临床资料及ERCP操作记录,并对失败原因及后续治疗措施的有效性进行统计分析。结果纳入ERCP操作2534例,其中失败57例,急诊ERCP失败率显著高于住院患者(6.19%vs1.26%,P<0.01)。ERCP失败原因中,初学者(52.6%)及熟练者(31.3%)以乳头形态异常更常见,且相比于精通者组更容易失败(P<0.05);补救治疗措施中,再次ERCP(65%)及药物保守治疗(60%)的成功率显著低于PTCD(93.8%)组(P<0.05);PTCD(56.3%)及药物保守治疗(60%)的再次治疗率显著高于手术(0%)及超声内镜(0%)组(P<0.05);临床缓解方面,药物保守治疗缓解率(60%)显著低于再次ERCP(95%)组(P<0.05)。结论急诊ERCP不建议初学者施行,而ERCP失败后的治疗,目前建议采取更积极的补救措施,具备条件时可优先选择超声内镜或手术治疗。
Objective To analyze the causes of endoscopic retrograde cholangiopancreatography(ERCP)failure in Beijing Friendship Hospital with a specific focus on the effectiveness of different salvage treatments to provide evidence for the treatment strategy selection after ERCP failure.Methods The patients who underwent ERCP at Beijing Friendship Hospital from June 1,2020 to September 1,2022 were enrolled,and the reasons and salvage treatment of the failure cases were analyzed.Results A total of 2534 ERCP cases were included,of which 57 cases failed.The failure rate of emergency ERCP was significantly higher than that of inpatients(6.19%vs.1.26%,P<0.01).Noticeably,papilla abnormality-resulted ERCP failure was much more common in beginners(52.6%)and proficient doctors(31.3%),as compared to skilled doctors(P<0.05).In salvage treatment,the success rate of second-ERCP(65%)and medication-based treatment(60%)was significantly lower than that of percutaneous transhepatic cholangial drainage(PTCD)(93.8%)(P<0.05).The re-treatment rate of PTCD(56.3%)and medication-based treatment(60%)was significantly higher than that of surgery(0%)and endoscopic ultrasonography(0%)(P<0.05).The clinical remission rate of medication-based treatment(60%)was significantly lower than that of second-ERCP(95%)(P<0.05).Conclusion Emergency ERCP is not recommended for beginners.For the treatment of ERCP failure,more active salvage treatment are recommended,and endoscopic ultrasonography or surgical treatment should be given priority if applicable.
作者
赵宇
张澍田
Zhao Yu;Zhang Shutian(Department of Gastroenterology,Bejing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《中华消化病与影像杂志（电子版）》
2023年第3期135-138,共4页
Chinese Journal of Digestion and Medical Imageology(Electronic Edition)
基金
国家自然科学基金重大科研仪器研制项目(82027801)。
关键词
内镜逆行胰胆管造影术
失败原因
补救治疗
缓解
Endoscopic retrograde cholangiopancreatography
Failed reasons
Salvage treatment
Remission
