Cawich Shamir O, Arthurs Milton, Murphy Trevor, Bonadie Kimon O, Roberts Hugh A, Naraynsingh Vijay
Hepatopancreatobiliary Surgeon, Department of Clinical Surgical Sciences, University of the West Indies, Trinidad & Tobago
Gastroenterologist, Faculty of Medicine, University of the West Indies, Kingston 7, Jamaica.
Trop Doct. 2015 Jan;45(1):15-20. doi: 10.1177/0049475514552550. Epub 2014 Oct 14.
Patients with sickle cell disease (SCD) demand special attention during clinical interventions because they are predisposed to acute chest syndrome (ACS), vaso-occlusive crises, intra-vascular haemolysis and immune paresis. Although SCD is endemic in the Caribbean, there has been no report on endoscopic retrograde cholangio-pancreatography (ERCP) outcomes in these patients from this region.
The records of patients with SCD who underwent ERCP between 1 January 2005 and 1 June 2010 were analysed retrospectively. Parameters assessed included patient demographics, procedural details, ERCP-related and SCD-related morbidity. Data were analysed using SPSS version 12.0.
Fifty-four patients with SCD were subjected to ERCP during the study period. There were 37 women and 17 men at a mean age of 28 years (SD +/-12.05). There was 29% (16) overall morbidity, with 10 (18.5%) SCD-related complications and six (11.1%) ERCP-specific complications. More common complications were: pancreatitis (9.3%); cholangitis (1.9%); ACS (9.3%); pneumonia (3.7%); and painful crises (5.6%). There was one death (1.9%) due to multiple organ failure secondary to severe pancreatitis.
This study suggests that the SCD cohort requires special perioperative attention to minimise the inordinately high morbidity, many of which are SCD-related. We propose a perioperative management protocol that may minimise morbidity in these patients.
镰状细胞病（SCD）患者在临床干预期间需要特别关注，因为他们易患急性胸部综合征（ACS）、血管闭塞性危机、血管内溶血和免疫麻痹。尽管SCD在加勒比地区为地方病，但该地区尚无关于这些患者内镜逆行胰胆管造影（ERCP）结果的报告。
对2005年1月1日至2010年6月1日期间接受ERCP的SCD患者记录进行回顾性分析。评估的参数包括患者人口统计学、手术细节、ERCP相关和SCD相关的发病率。使用SPSS 12.0版对数据进行分析。
研究期间54例SCD患者接受了ERCP。有37名女性和17名男性，平均年龄28岁（标准差±12.05）。总体发病率为29%（16例），其中10例（18.5%）为SCD相关并发症，6例（11.1%）为ERCP特异性并发症。较常见的并发症有：胰腺炎（9.3%）；胆管炎（1.9%）；ACS（9.3%）；肺炎（3.7%）；疼痛性危机（5.6%）。有1例（1.9%）因严重胰腺炎继发多器官衰竭死亡。
本研究表明，SCD患者队列需要围手术期特别关注，以尽量减少过高的发病率，其中许多与SCD相关。我们提出了一种围手术期管理方案，可能会降低这些患者的发病率。
