CAJ | 학술논문

目的探讨应用逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)诊治时行Oddi括约肌切开术(endoscopic sphincterotomy,EST)病人的近期及远期并发症发生情况以及并发症的发生是否与乳头切开大小相关.方法研究并随访95例接受内镜下EST术病人,按术中乳头切开的程度分为大、中、小切开3组,统计EST术近期及远期并发症的发生情况.结果 95例EST病人近期并发症发生率为18.94%(18/95),包括术中出血11例、迟发出血3例、术后急性胰腺炎1例及胆管炎病人2例,经对症治疗后好转出院,但1例行EST大切开的憩室内乳头病人因并发十二指肠穿孔,抢救无效病死;95例随访者中出现远期并发症者共11例(11.57%),其中胆系感染5例、再发结石3例、乳头狭窄1例及慢性复发性胰腺炎2例,分别经再次ERCP治疗及对症药物治疗症状好转;经统计学分析,EST大、中、小切开的近期(χ2=2.433,P=0.296)及远期并发症(χ2=1.151,P=0.562)发生率之间无显著性差异,且切开大小与术中出血并发症(P=0.109)及总的近期(P=0.124)、远期并发症(P=0.402)之间无相关性.结论 EST术后存在很多近期及远期并发症,乳头切开程度与术后并发症之间无明确相关性,ERCP操作时精确把握切开方向、避免血管损伤、保持胆汁胰液引流通畅及尽量保护Oddi括约肌功能免受损伤能有效避免术后并发症的发生.
목적 탐토응용역행이담관조영(endoscopic retrograde cholangiopancreatography,ERCP)진치시행Oddi괄약기절개술(endoscopic sphincterotomy,EST)병인적근기급원기병발증발생정황이급병발증적발생시부여유두절개대소상관.방법 연구병수방95례접수내경하EST술병인,안술중유두절개적정도분위대、중、소절개3조,통계EST술근기급원기병발증적발생정황.결과 95례EST병인근기병발증발생솔위18.94%(18/95),포괄술중출혈11례、지발출혈3례、술후급성이선염1례급담관염병인2례,경대증치료후호전출원,단1례행EST대절개적게실내유두병인인병발십이지장천공,창구무효병사;95례수방자중출현원기병발증자공11례(11.57%),기중담계감염5례、재발결석3례、유두협착1례급만성복발성이선염2례,분별경재차ERCP치료급대증약물치료증상호전;경통계학분석,EST대、중、소절개적근기(χ2=2.433,P=0.296)급원기병발증(χ2=1.151,P=0.562)발생솔지간무현저성차이,차절개대소여술중출혈병발증(P=0.109)급총적근기(P=0.124)、원기병발증(P=0.402)지간무상관성.결론 EST술후존재흔다근기급원기병발증,유두절개정도여술후병발증지간무명학상관성,ERCP조작시정학파악절개방향、피면혈관손상、보지담즙이액인류통창급진량보호Oddi괄약기공능면수손상능유효피면술후병발증적발생.
Objective To investigate the short- and long-term complications after endoscopic Oddi's sphincterotomy (EST) upon endoscopic retrograde cholangiopancreatography (ERCP) procedure and determine whether the size of EST correlates to the occurrence of EST complications.Methods 95 cases receiving EST in the process of ERCP in our hospital were studied and followed up. The patients were divided into large, moderate and small incision groups according to the size of EST and the states of short-term and long-term EST complications were statistically analyzed.Results The incidence of short-term complications of EST was 18. 94% (18/95). They included bleeding in the process of ERCP in 11 cases, delayed bleeding in 3, acute pancreatitis in 1, acute cholangitis in 2 and duodenal perforation in 1. All these patients but 1 with duodenal perforation were discharged after undergoing symptomatic treatments. Eleven out of the 95 patients had long-term complications (11.57 % ). These included biliary system infection in 5 cases, recurrent calculus of bile duct in 3, papilla stricture in 1 and chronic relapsing pancreatitis in 2. All 11 patients recovered after therapeutic ERCP again or symptomatic drug treatments. There was no significant difference in incidence of short-term (χ2 =2.433, P=0.296) or long-term complications (χ2 = 1.151, P=0.562) among the 3 groups. Furthermore, there was no statistical correlation between the incision size of Oddi and complications including operative bleeding (P=0.109), short-term complications (P=0.124) and longterm complications(P=0.402). Conclusion There are many short-term and long-term complications after EST, but there is no correlation between the complications and the incision size of Oddi. The occurring rate of complications might be reduced through accurate direction of papilla incision, avoidance from injury of blood vessel, keeping bile drainage unobstructed and protection of the function of Oddi sphincter as far as possible in the process of ERCP.