Nelson D B, Freeman M L
Minneapolis VA Medical Center, Gastroenterology Section (111D), MN 55417.
J Clin Gastroenterol. 1994 Dec;19(4):283-7. doi: 10.1097/00004836-199412000-00004.
We carried out a retrospective cohort study on all patients undergoing sphincterotomy at our institution over a 4-year period. Major hemorrhage occurred in 10 of 189 patients (5.3%). Onset was usually delayed (mean, 3.0 days; range, 0-9 days). Six potential risk factors for postsphincterotomy hemorrhage were assessed by univariate and multivariate analysis. Three factors predicted postsphincterotomy hemorrhage: hemodialysis (relative risk, 8.4; 95% confidence interval, CI, 2.7-26.4), a prothrombin time prolonged at least 2 s above control (relative risk, 7.8; 95% CI, 2.4-25.6), and endoscopically observed bleeding at the time of sphincterotomy (relative risk, 5.9; 95% CI, 1.7-20.1). Features not independently associated with hemorrhage were sphincter of Oddi dysfunction, aspirin or nonsteroidal anti-inflammatory drug (NSAID) use within 1 week prior to sphincterotomy, and sphincterotomy length. When differentiated from endoscopically observed bleeding, clinically significant hemorrhage was usually a delayed complication, primarily in patients with hemostatic defects.
我们对本机构4年内所有接受括约肌切开术的患者进行了一项回顾性队列研究。189例患者中有10例（5.3%）发生大出血。出血通常延迟出现（平均3.0天；范围0 - 9天）。通过单因素和多因素分析评估了括约肌切开术后出血的6个潜在危险因素。三个因素可预测括约肌切开术后出血：血液透析（相对危险度，8.4；95%可信区间，CI，2.7 - 26.4），凝血酶原时间比对照延长至少2秒（相对危险度，7.8；95%CI，2.4 - 25.6），以及括约肌切开术时内镜观察到出血（相对危险度，5.9；95%CI，1.7 - 20.1）。与出血无独立关联的特征包括Oddi括约肌功能障碍、括约肌切开术前1周内使用阿司匹林或非甾体抗炎药（NSAID）以及括约肌切开术的长度。与内镜观察到的出血相鉴别时，具有临床意义的出血通常是一种延迟并发症，主要发生在有止血缺陷的患者中。
