CAJ | 학술논문

目的分析胆总管结石患者内镜下取石的术中、术后1周内的并发症发生率,探讨其影响因素.方法收集136例胆总管结石患者内镜下取石的临床资料,从结石数量、大小、首发或再发、有无胆管炎等方面分析它们对术中及术后并发症发生的影响,并观察留置鼻胆管的效果.结果单发结石组1次取石成功率高,术中乳头出血、贲门撕裂,术后高淀粉酶血症、AP的发生率均较多发结石组显著降低(P<0.05);<2 cm结石组1次取石成功率也高,术中乳头出血、结石嵌顿、贲门撕裂、低氧血症,术后高淀粉酶血症、AP及胆系感染的发生率均较≥2 cm结石组显著降低;初发结石组1次取石成功率低,术中乳头出血、结石嵌顿,术后高淀粉酶血症、AP及胆系感染的发生率均较再发结石组显著升高;并发胆管炎组1次取石成功率低,术中乳头出血、低氧血症,术后高淀粉酶血症、MAP及胆系感染的发生率均较无胆管炎组显著升高.留置鼻胆管后,乳头出血的发生率显著升高,而高淀粉酶血症、AP、胆系感染的发生率则显著降低.结论影响胆总管结石患者内镜下取石的因素有结石数量、大小、初发或再发、并发胆管炎等,取石术后留置鼻胆管可减少并发症的发生,但易引起乳头出血.
목적 분석담총관결석환자내경하취석적술중、술후1주내적병발증발생솔,탐토기영향인소.방법 수집136례담총관결석환자내경하취석적림상자료,종결석수량、대소、수발혹재발、유무담관염등방면분석타문대술중급술후병발증발생적영향,병관찰류치비담관적효과.결과 단발결석조1차취석성공솔고,술중유두출혈、분문시렬,술후고정분매혈증、AP적발생솔균교다발결석조현저강저(P<0.05);<2 cm결석조1차취석성공솔야고,술중유두출혈、결석감돈、분문시렬、저양혈증,술후고정분매혈증、AP급담계감염적발생솔균교≥2 cm결석조현저강저;초발결석조1차취석성공솔저,술중유두출혈、결석감돈,술후고정분매혈증、AP급담계감염적발생솔균교재발결석조현저승고;병발담관염조1차취석성공솔저,술중유두출혈、저양혈증,술후고정분매혈증、MAP급담계감염적발생솔균교무담관염조현저승고.류치비담관후,유두출혈적발생솔현저승고,이고정분매혈증、AP、담계감염적발생솔칙현저강저.결론 영향담총관결석환자내경하취석적인소유결석수량、대소、초발혹재발、병발담관염등,취석술후류치비담관가감소병발증적발생,단역인기유두출혈.
Objective To investigate the factors predicting endoscopic stone extraction complications during operation and 1 week within operation. Methods The clinical data of 136 patients with common duet stones during endoscopic procedures and 1 week within procedures were collected, and the impacts of the number, size of stones, and the first-attack versus recurrent-attack stone, with or without cholangeitis on the complications during operation and 1 week within operation were analyzed, and the effect of nasobiliary drainage was investigated. Results The success rate in single-stone group was high, the incidences of complications during endoscopy including sphincter hemorrhage, cardiac laceration, hyperamylasemia, acute pancreatitis were significantly lower than those in the multi-stones group ( P < 0. 05 ). The group of < 2 cm stone also had high success rate of stone extraction, the incidences of complications including sphincter hemorrhage, stone impaction, cardiac laceration, hyperamylasemia, acute pancreatitis were significantly lower than those in the ≥2 cm group. The first-attack group had low success rate of stone extraction, the incidences of complications including sphincter hemorrhage, stone impaction, hyperamylasemia, acute pancreatitis and biliary infection were significantly higher than those in the recurrent-attack group. The patients with cholangeitis had low success rate of stone extraction, the incidences of complications including sphincter hemorrhage, hypoxemia, hyperamylasemia, acute pancreatitis and biliary infection were significantly higher than those without cholangeitis. After nasobiliary drainage, the incidences of hyperamylasemia, acute pancreatitis and biliary infection significantly decreased while the incidence of sphincter hemorrhage significantly increased. Conclusions The number, size of stones, and the first-attack versus recurrent-attack stone, symptoms with orwithout cholangeitis could predict the complications of stone extraction;post-ERCP nssobiliary drainage could decrease the complications, but increase the possibility of sphincter hemorrhage.