内镜逆行胰胆管造影术（ERCP）相关并发症的危险因素：一项前瞻性多中心研究。

Risk factors for ERCP-related complications: a prospective multicenter study.

作者信息

Wang Peng, Li Zhao-Shen, Liu Feng, Ren Xu, Lu Nong-Hua, Fan Zhi-Ning, Huang Qiang, Zhang Xiao, He Li-Ping, Sun Wen-Sheng, Zhao Qiu, Shi Rui-Hua, Tian Zi-Bin, Li Yan-Qing, Li Wen, Zhi Fa-Chao

机构信息

Department of Gastroenterology, Changhai Hospital, Second Military Medical University, 174 Changhai Road, Shanghai, China.

出版信息

Am J Gastroenterol. 2009 Jan;104(1):31-40. doi: 10.1038/ajg.2008.5.

DOI:10.1038/ajg.2008.5

PMID:19098846

Abstract

OBJECTIVES

To investigate the potential risk factors for endoscopic retrograde cholangiopancreatography (ERCP) complications and to identify whether the risk factors are different for pancreatitis and asymptomatic hyperamylasemia.

METHODS

Consecutive ERCP procedures were studied at 14 centers in China from May 2006 to April 2007. The complications after the patients' first-only procedures were evaluated. Multivariate analysis based on the first-only procedures was used to identify the risk factors.

RESULTS

A total of 3,178 procedures were performed on 2,691 patients. Overall, complications developed in 213 (7.92%) patients, pancreatitis in 116 (4.31%), and asymptomatic hyperamylasemia in 396 (14.72%). In the multivariate analysis, female gender (adjusted odds ratios (ORs): 1.52, 95% confidence interval (CI): 1.14-2.02, P=0.004), periampullary diverticulum (OR: 2.02, 95% CI: 1.49-2.73, P<0.001), cannulation time >10 min (OR: 1.51, 95% CI: 1.08-2.10, P=0.016), > or =1 pancreatic deep wire pass (OR: 1.80, 95% CI: 1.33-2.42, P<0.001), and needle-knife precut (OR: 2.70, 95% CI: 1.42-5.14, P=0.002) were risk factors for overall complications. Female gender (OR: 1.84, 95% CI: 1.25-2.70, P=0.002), age < or =60 year (OR: 1.59, 95% CI: 1.06-2.39, P=0.025), cannulation time>10 min (OR: 1.76, 95% CI: 1.13-2.74, P=0.012), > or =1 pancreatic deep wire pass (OR: 2.77, 95% CI: 1.79-4.30, P<0.001), and needle-knife precut (OR: 4.34, 95% CI: 1.92-9.79, P<0.001) were risk factors for pancreatitis. Cannulation time>10 min (OR: 1.96, 95% CI: 1.52-2.54, P<0.001), > or =1 pancreatic deep wire pass (OR: 2.24, 95% CI: 1.74-2.89, P<0.001), needle-knife precut (OR: 2.34, 95% CI: 1.32-4.14, P=0.004), and major papilla pancreatic sphincterotomy (OR: 1.71, 95% CI: 1.23-2.37, P=0.001) were risk factors for asymptomatic hyperamylasemia.

CONCLUSIONS

Patient-related factors are as important as procedure-related factors in determining high-risk predictors for post-ERCP overall complications and pancreatitis. However, the risk factors for asymptomatic hyperamylasemia may be mostly procedure related.

摘要

目的

探讨内镜逆行胰胆管造影术（ERCP）并发症的潜在危险因素，并确定胰腺炎和无症状高淀粉酶血症的危险因素是否不同。

方法

2006年5月至2007年4月在中国14个中心对连续进行的ERCP手术进行研究。评估患者首次手术后的并发症。基于首次手术进行多因素分析以确定危险因素。

结果

共对2691例患者进行了3178例手术。总体而言，213例（7.92%）患者发生并发症，116例（4.31%）发生胰腺炎，396例（14.72%）发生无症状高淀粉酶血症。多因素分析中，女性（校正比值比（OR）：1.52，95%置信区间（CI）：1.14 - 2.02，P = 0.004）、壶腹周围憩室（OR：2.02，95% CI：1.49 - 2.73，P < 0.001）、插管时间>10分钟（OR：1.51，95% CI：1.08 - 2.10，P = 0.016）、≥1次胰腺深部导丝插入（OR：1.80，95% CI：1.33 - 2.42，P < 0.001）和针刀预切开（OR：2.70，95% CI：1.42 - 5.14，P = 0.002）是总体并发症的危险因素。女性（OR：1.84，95% CI：1.25 - 2.70，P = 0.002）、年龄≤60岁（OR：1.59，95% CI：1.06 - 2.39，P = 0.025）、插管时间>10分钟（OR：1.76，95% CI：1.13 - 2.74，P = 0.012）、≥1次胰腺深部导丝插入（OR：2.77，95% CI：1.79 - 4.30，P < 0.001）和针刀预切开（OR：4.34，95% CI：1.92 - 9.79，P < 0.001）是胰腺炎的危险因素。插管时间>10分钟（OR：1.96，95% CI：1.52 - 2.54，P < 0.001）、≥1次胰腺深部导丝插入（OR：2.24，95% CI：1.74 - 2.89，P < 0.001）、针刀预切开（OR：2.34，95% CI：1.32 - 4.14，P = 0.004）和主乳头胰括约肌切开术（OR：1.71，95% CI：1.23 - 2.37，P = 0.001）是无症状高淀粉酶血症的危险因素。