内镜括约肌切开术的并发症：肝素能否预防ERCP术后急性胰腺炎？

Complications of endoscopic sphincterotomy: can heparin prevent acute pancreatitis after ERCP?

作者信息

Rabenstein Thomas, Roggenbuck Sylvia, Framke Baerbel, Martus Peter, Fischer Bernhard, Nusko Gerhard, Muehldorfer Steffen, Hochberger Juergen, Ell Christian, Hahn Eckhart G, Schneider H Thomas

机构信息

Department of Medicine I and Department for Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Germany.

出版信息

Gastrointest Endosc. 2002 Apr;55(4):476-83. doi: 10.1067/mge.2002.122616.

DOI:10.1067/mge.2002.122616

PMID:11923757

Abstract

BACKGROUND

An exploratory analysis of a prospective study of risk factors for acute pancreatitis after ERCP combined with endoscopic sphincterotomy showed that the frequency of acute pancreatitis was lower in patients who received heparin compared with patients not treated with heparin. The study was continued to further analyze the effect of heparin on the frequency of acute pancreatitis.

METHODS

Potential risk factors for acute pancreatitis and outcomes were evaluated prospectively for all ERCP procedures with endoscopic sphincterotomy performed between September 1994 and December 1998. The results were analyzed by univariate and multivariate methods to determine risk factors for complications. Heparin was administered to 32.9% of the patients (heparin group [HEP group], n = 268) for various clinical reasons (low-molecular-weight heparin, n = 208, unfractionated heparin n = 60). A group of 547 patients who did not receive heparin served as control patients (CON group).

RESULTS

Eight hundred fifteen patients underwent ERCP with endoscopic sphincterotomy; acute pancreatitis occurred in 6.4% (n = 52). The frequency of acute pancreatitis was significantly lower in the HEP group versus the CON group in the final multivariate model, which included significant risk factors for acute pancreatitis (HEP group: 3.4%, 9/268 vs. CON group: 7.9%, 43/547; p = 0.005). HEP did not increase the risk of hemorrhage (HEP group: 1.1%, 3/268, 2 severe, none fatal vs. CON group: 2.0%, 11/547, 3 severe, 2 fatal). HEP (p = 0.005; OR 0.3: 95% CI [0.16, 0.73]) and the number of risk factors present (p = 0.0001; OR 2.5: 95% CI [1.80, 3.50]) influenced the frequency of acute pancreatitis independently.

CONCLUSIONS

Heparin was significantly associated with an extremely low frequency of post-ERCP pancreatitis without increasing the risk of hemorrhage after endoscopic sphincterotomy. Because this effect could not be attributed to other known or suspected confounders, our conclusion was that heparin administration before ERCP reduces the risk of pancreatitis.

摘要

背景

一项关于内镜逆行胰胆管造影术（ERCP）联合内镜括约肌切开术后急性胰腺炎危险因素的前瞻性研究的探索性分析表明，与未接受肝素治疗的患者相比，接受肝素治疗的患者急性胰腺炎的发生率较低。该研究继续进行，以进一步分析肝素对急性胰腺炎发生率的影响。

方法

对1994年9月至1998年12月期间所有进行内镜括约肌切开术的ERCP手术的急性胰腺炎潜在危险因素和结果进行前瞻性评估。通过单变量和多变量方法分析结果，以确定并发症的危险因素。因各种临床原因，32.9%的患者接受了肝素治疗（肝素组[HEP组]，n = 268）（低分子量肝素，n = 208；普通肝素，n = 60）。一组547例未接受肝素治疗的患者作为对照患者（CON组）。

结果

815例患者接受了ERCP联合内镜括约肌切开术；急性胰腺炎发生率为6.4%（n = 52）。在最终的多变量模型中，HEP组急性胰腺炎的发生率显著低于CON组，该模型纳入了急性胰腺炎的显著危险因素（HEP组：3.4%，9/268；CON组：7.9%，43/547；p = 0.005）。肝素未增加出血风险（HEP组：1.1%，3/268，2例严重，无死亡；CON组：2.0%，11/547，3例严重，2例死亡）。肝素（p = 0.005；OR 0.3：95%CI[0.16，0.73]）和存在的危险因素数量（p = 0.0001；OR 2.5：95%CI[1.80，3.50]）独立影响急性胰腺炎的发生率。