治疗性内镜逆行胰胆管造影术前多学科团队会议：一项纳入1909例病例的前瞻性研究。
Multidisciplinary team meeting before therapeutic ERCP: A prospective study with 1,909 cases.
作者信息
Liao Zhuan, Hu Liang-Hao, Li Zhao-Shen, Zuo Chang-Jing, Wang Li, Jin Gang, Zou Duo-Wu, Jin Zhen-Dong, Li Shu-De, Liu Feng, Chen Jie, Zhan Xian-Bao, Yuan Jin-Hua, Wang Luo-Wei, Wang Dong
机构信息
Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
出版信息
J Interv Gastroenterol. 2011 Apr-Jun;1(2):64-69. doi: 10.4161/jig.1.2.15047.
OBJECTIVE
To determine the effect of multidisciplinary team meeting (MDTM) on the success rate and complications of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for hepato-pancreato-biliary diseases.
METHODS
All patients undergoing their first therapeutic ERCP over a 21-month period of time in a tertiary care medical center were included. Generally, patients scheduled for ERCP on Friday, Saturday, Sunday, and Monday were subject to MDTM group, and those on Tuesday, Wednesday, and Thursday were allocated to the control group. For each MDTM case, an MDTM was held on the Tuesday prior to the scheduled ERCP. At the meeting, the cases were discussed by a team consisting of chief physicians, radiologists, endoscopists, anesthetists, and surgeons, and a decision was made on the schedule of ERCP. For control cases, a clinical team of one chief physician and two attending physicians made the decision.
RESULTS
From April 2006 to December 2007, 912 and 997 ERCP procedures were allocated to the MDTM and control groups, respectively. There was no significant difference in the baseline characteristics and indications between the two groups. Although the success rates were not significantly different between MDTM and control groups (82.9% vs. 84.8%, P=0.321), MDTM was significantly associated with a decreased overall complication rate of (6.9% vs. 12.0%, p<0.001) and severe complication rate (0.4% vs. 2.5%, p=0.035).
CONCLUSIONS
Pre-ERCP MDTM decreases the frequency and severity of ERCP-related complications, with similar success rate, compared to routine practice.
目的
确定多学科团队会议（MDTM）对治疗性内镜逆行胰胆管造影术（ERCP）治疗肝胰胆疾病的成功率及并发症的影响。
方法
纳入在一家三级医疗中心接受首次治疗性ERCP的所有患者，治疗时间跨度为21个月。一般来说，安排在周五、周六、周日及周一进行ERCP的患者归入MDTM组，而安排在周二、周三及周四的患者被分配至对照组。对于每例MDTM病例，在预定的ERCP之前的周二举行MDTM会议。会上，由主任医师、放射科医生、内镜医师、麻醉师及外科医生组成的团队对病例进行讨论，并就ERCP的日程安排做出决定。对于对照病例，由一名主任医师和两名主治医师组成的临床团队做出决定。
结果
从2006年4月至2007年12月，分别有912例和997例ERCP手术被分配至MDTM组和对照组。两组之间的基线特征和适应证无显著差异。虽然MDTM组和对照组的成功率无显著差异（82.9%对84.8%，P = 0.321），但MDTM与总体并发症发生率降低显著相关（6.9%对12.0%，p<0.001）以及严重并发症发生率降低相关（0.4%对2.5%，p = 0.035）。
结论
与常规做法相比，ERCP前的MDTM可降低ERCP相关并发症的发生率及严重程度，成功率相似。
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