巴西一家三级医疗中心的内镜逆行胰胆管造影术：关注新的风险因素、并发症及质量指标
ERCP PERFORMANCE IN A TERTIARY BRAZILIAN CENTER: FOCUS ON NEW RISK FACTORS, COMPLICATIONS AND QUALITY INDICATORS.
作者信息
Borges Alana Costa, Almeida Paulo César de, Furlani Stella Maria Torres, Cury Marcelo de Sousa, Pleskow Douglas K
机构信息
Zilda Arns Hospital and Maternity, Gastrointestinal Endoscopy, Fortaleza, CE, Brasil.
State University of Ceará, Center for Health Sciences, Fortaleza, CE, Brasil.
出版信息
Arq Bras Cir Dig. 2018 Jun 21;31(1):e1348. doi: 10.1590/0102-672020180001e1348.
BACKGROUND
ERCP can lead to complications, which can be prevented by the recognition of risk factors.
AIM
To identify these risk factors, with quality evaluation.
METHODS
Retrospective study in a Brazilian hospital in 194 patients, excluding surgically altered anatomy.
RESULTS
211 ERCPs were performed: 97.6% were therapeutic, 83.4% were started by trainees, with deep cannulation rate of 89.6%. Precut was needed in 16.6% of the ERCPs and classic sphincterotomy in 67.3%, with 75.4% of ductal clearance at single session and 8.0% of technical failure. Inacessible papillas ocurred in 2.5% of cases. There were 2.5% of late complications and 16% of early complications. Multivariate analysis identified six predictors for early complications: fistulotomy precut (OR=3.4, p=0.010), difficult cannulation (OR=21.5, p=0.002), attending's procedural time (OR=2.4, p=0.020), choledocholithiasis (adjusted OR=1.8, p=0.015), cannulation time (adjusted OR=3.2, p=0.018) and ERCP duration (adjusted OR=2.7, p=0.041).
CONCLUSION
Six risk factors for post-ERCP complications were identified. ERCP duration and cannulation time are suggested as new potential quality indicators.
背景
内镜逆行胰胆管造影术（ERCP）可导致并发症，识别危险因素可预防这些并发症。
目的
识别这些危险因素并进行质量评估。
方法
对巴西一家医院的194例患者进行回顾性研究，排除手术改变的解剖结构。
结果
共进行了211例ERCP：97.6%为治疗性操作，83.4%由实习生启动，深度插管率为89.6%。16.6%的ERCP需要进行预切开，67.3%需要进行经典括约肌切开术，单次操作胆管清除率为75.4%，技术失败率为8.0%。2.5%的病例出现乳头难以插管。晚期并发症发生率为2.5%，早期并发症发生率为16%。多因素分析确定了早期并发症的六个预测因素：预切开瘘管切开术（比值比[OR]=3.4，p=0.010）、插管困难（OR=21.5，p=0.002）、主治医生操作时间（OR=2.4，p=0.020）、胆总管结石（校正OR=1.8，p=0.015）、插管时间（校正OR=3.2，p=0.018）和ERCP持续时间（校正OR=2.7，p=0.041）。
结论
确定了ERCP术后并发症的六个危险因素。建议将ERCP持续时间和插管时间作为新的潜在质量指标。
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