Kim Ga Hee, Ryoo Si Kyong, Park Jae Keun, Park Joo Kyung, Lee Kwang Hyuck, Lee Kyu Taek, Lee Jong Kyun
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Clin Endosc. 2019 Nov;52(6):598-605. doi: 10.5946/ce.2018.177. Epub 2019 May 28.
BACKGROUND/AIMS: For the treatment of malignant biliary obstruction, endoscopic retrograde biliary drainage (ERBD) has been widely accepted as a standard procedure. However, post-ERBD complications can affect the lives of patients. The purpose of this study was to identify the predictive factors for these complications, including the patient's status, cancer status, and stent type.
This was a retrospective analysis conducted in a single tertiary hospital from January 2007 to July 2017. The following variables were evaluated: sex, age, body mass index, cancer type, history of pancreatitis, gallbladder stone, previous biliary stenting, precut papillotomy, stent type, contrast injection into the pancreatic duct or gallbladder, cystic duct invasion by the tumor, and occlusion of the cystic duct orifice by a metal stent.
Multivariate analysis showed that contrast injection into the pancreatic duct was a risk factor for pancreatitis. Patients with a history of bile drainage showed a lower risk of pancreatitis. For cholecystitis, the analysis revealed contrast injection into the gallbladder and cystic duct invasion by the tumor as important predictive factors. Metal stents showed a greater risk of post-procedure pancreatitis than plastic stents, but did not affect the incidence of cholecystitis.
Considering that contrast injection is the most important factor for both complications, a careful approach by the physician is essential in preventing the occurrence of any complications. Further, choosing the type of stent is an important factor for patients at a risk of post-procedure pancreatitis.
背景/目的：对于恶性胆管梗阻的治疗，内镜逆行胆管引流术（ERBD）已被广泛接受为标准手术。然而，ERBD术后并发症会影响患者的生活。本研究的目的是确定这些并发症的预测因素，包括患者状况、癌症状况和支架类型。
这是一项在一家三级医院于2007年1月至2017年7月进行的回顾性分析。评估了以下变量：性别、年龄、体重指数、癌症类型、胰腺炎病史、胆囊结石、既往胆管支架置入、预切开乳头括约肌、支架类型、向胰管或胆囊内注入造影剂、肿瘤侵犯胆囊管以及金属支架阻塞胆囊管开口。
多因素分析显示，向胰管内注入造影剂是胰腺炎的危险因素。有胆汁引流史的患者胰腺炎风险较低。对于胆囊炎，分析显示向胆囊内注入造影剂和肿瘤侵犯胆囊管是重要的预测因素。金属支架术后胰腺炎的风险高于塑料支架，但不影响胆囊炎的发生率。
鉴于注入造影剂是两种并发症的最重要因素，医生谨慎操作对于预防任何并发症的发生至关重要。此外，对于有术后胰腺炎风险的患者，选择支架类型是一个重要因素。
