胰腺分裂患者行内镜逆行胰胆管造影相关并发症的危险因素：一项回顾性研究。
Risk factors for ERCP-related complications in patients with pancreas divisum: a retrospective study.
机构信息
Indiana University, Indianapolis, Indiana, USA.
出版信息
Gastrointest Endosc. 2011 May;73(5):963-70. doi: 10.1016/j.gie.2010.12.035. Epub 2011 Mar 9.
BACKGROUND
Limited data are available on complication rates of ERCP in patients with pancreas divisum (PD), and it is unclear whether traditional risk factors for post-ERCP pancreatitis (PEP) apply.
OBJECTIVES
To describe the rates of ERCP complications in patients with PD and assess patient and procedure-related risk factors for PEP.
DESIGN
Retrospective cohort study.
SETTING
Tertiary care referral center.
PATIENTS
A total of 2753 ERCPs performed in 1476 patients with PD from 1997 to 2010.
MAIN OUTCOME MEASUREMENTS
Rates of PEP, hemorrhage, perforation, cholecystitis, and hospitalization directly attributable to ERCP.
RESULTS
Early complications occurred after 7.8% of procedures, with PEP, hemorrhage, perforation, cholecystitis, and cardiorespiratory complications in 6.8%, 0.7%, 0.2%, 0.1%, and 0.1% of procedures, respectively. PEP was uncommon in patients who did not undergo attempted dorsal duct cannulation, occurring in 1.2% of procedures. With dorsal duct cannulation and cannulation with minor papilla sphincterotomy (MiS), the rates of PEP increased significantly to 8.2% and 10.6%, respectively (P<.01 for each comparison). Significant predictors of PEP after multivariate logistic regression included age younger than 40 (odds ratio [OR] 1.8; 95% CI, 1.27-2.59), female sex (OR 1.94; 95% CI, 1.25-3.01), previous PEP (OR 2.02; 95% CI, 1.32-3.1), attempted dorsal duct cannulation (OR 7.45; 95% CI, 3.25-17.07), and MiS (OR 1.62; 95% CI, 1.05-2.48). Presence of severe chronic pancreatitis was a protective factor (OR 0.46; 95% CI, 0.22-0.98).
LIMITATIONS
Retrospective analysis of prospectively collected data.
CONCLUSIONS
Among patients with PD, the rate of PEP is low (1.2%) if dorsal duct cannulation is not attempted. However, patients with PD undergoing dorsal duct cannulation with or without MiS are at high risk of PEP (8.2% without and 10.6% with). Traditional PEP risk factors apply to patients with PD.
背景
目前关于胰腺分裂症（PD）患者行内镜逆行胰胆管造影术（ERCP）后并发症发生率的数据有限，并且目前尚不清楚传统的 ERCP 后胰腺炎（PEP）危险因素是否适用。
目的
描述 PD 患者行 ERCP 后的并发症发生率，并评估患者和操作相关因素与 PEP 的关系。
设计
回顾性队列研究。
地点
三级转诊中心。
患者
1997 年至 2010 年，共对 1476 例 PD 患者的 2753 例 ERCP 进行了分析。
主要观察指标
PEP、出血、穿孔、胆囊炎和直接归因于 ERCP 的住院治疗的发生率。
结果
术后 7.8%的患者发生早期并发症，PEP、出血、穿孔、胆囊炎和心肺并发症的发生率分别为 6.8%、0.7%、0.2%、0.1%和 0.1%。未行胰管背侧插管的患者 PEP 发生率较低，为 1.2%。胰管背侧插管和小乳头括约肌切开术（MiS）的 PEP 发生率分别显著增加至 8.2%和 10.6%（每种比较的 P<.01）。多变量逻辑回归分析表明，PEP 的显著预测因子包括年龄<40 岁（比值比[OR] 1.8；95%置信区间，1.27-2.59）、女性（OR 1.94；95%置信区间，1.25-3.01）、既往有 PEP（OR 2.02；95%置信区间，1.32-3.1）、行胰管背侧插管（OR 7.45；95%置信区间，3.25-17.07）和 MiS（OR 1.62；95%置信区间，1.05-2.48）。严重慢性胰腺炎的存在是保护因素（OR 0.46；95%置信区间，0.22-0.98）。
局限性
对前瞻性收集的数据进行回顾性分析。
结论
在 PD 患者中，如果不尝试胰管背侧插管，PEP 的发生率较低（1.2%）。然而，行胰管背侧插管和（或）MiS 的 PD 患者发生 PEP 的风险较高（无 MiS 为 8.2%，有 MiS 为 10.6%）。传统的 PEP 危险因素也适用于 PD 患者。
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