中华消化内镜杂志
中華消化內鏡雜誌
중화소화내경잡지
Chinese Journal of Digestive Endoscopy
2015年
7期
452-456
,共5页
ERCP%上消化道出血%危险因素%治疗
ERCP%上消化道齣血%危險因素%治療
ERCP%상소화도출혈%위험인소%치료
Cholangiopancreatography,endoscopic retrograde%Upper gastrointestinal bleeding%Risk factors%Prevention
目的 探讨经内镜逆行胰胆管造影术(ERCP)取石并发上消化道出血的危险因素及防治方法.方法 回顾性分析2014年1月至2014年12月在皖南医学院附属弋矶山医院接受ERCP患者的临床资料,收集可能与ERCP取石术迟发出血有关的危险因素进行单因素和多因素分析,寻找ERCP取石术迟发出血的独立危险因素.结果 符合入组标准者383例,男157例、女226例,年龄最小19岁,最大88岁.并发消化道出血患者41例(10.7％),术中出血27例(7.0％),术后出血14例(3.7％);其中轻度出血28例,中度出血9例(4例为贲门黏膜撕裂),重度出血4例.患者均痊愈出院,无一例外科治疗及死亡.单因素分析发现阿司匹林/氢氯吡格雷片服药史、胆管炎、巨大憩室及憩室内乳头为ERCP取石术迟发出血的危险因素(P＜0.05).多因素分析显示胆管炎(OR=4.125,95％ CI:1.306～ 13.031,P＜0.05)、阿司匹林/氢氯吡格雷片服药史(OR=10.220,95％ CI:2.997～34.853,P＜0.01)及憩室内乳头(OR=14.064,95％ CI:1.888 ～ 104.762,P＜0.05)为ERCP取石术迟发出血的独立危险因素.结论 胆管炎、阿司匹林/氢氯吡格雷片服药史及憩室内乳头使ERCP取石患者并发上消化道迟发出血的风险增加.如发生出血,积极止血,尤其内镜下止血至关重要.
目的 探討經內鏡逆行胰膽管造影術(ERCP)取石併髮上消化道齣血的危險因素及防治方法.方法 迴顧性分析2014年1月至2014年12月在皖南醫學院附屬弋磯山醫院接受ERCP患者的臨床資料,收集可能與ERCP取石術遲髮齣血有關的危險因素進行單因素和多因素分析,尋找ERCP取石術遲髮齣血的獨立危險因素.結果 符閤入組標準者383例,男157例、女226例,年齡最小19歲,最大88歲.併髮消化道齣血患者41例(10.7％),術中齣血27例(7.0％),術後齣血14例(3.7％);其中輕度齣血28例,中度齣血9例(4例為賁門黏膜撕裂),重度齣血4例.患者均痊愈齣院,無一例外科治療及死亡.單因素分析髮現阿司匹林/氫氯吡格雷片服藥史、膽管炎、巨大憩室及憩室內乳頭為ERCP取石術遲髮齣血的危險因素(P＜0.05).多因素分析顯示膽管炎(OR=4.125,95％ CI:1.306～ 13.031,P＜0.05)、阿司匹林/氫氯吡格雷片服藥史(OR=10.220,95％ CI:2.997～34.853,P＜0.01)及憩室內乳頭(OR=14.064,95％ CI:1.888 ～ 104.762,P＜0.05)為ERCP取石術遲髮齣血的獨立危險因素.結論 膽管炎、阿司匹林/氫氯吡格雷片服藥史及憩室內乳頭使ERCP取石患者併髮上消化道遲髮齣血的風險增加.如髮生齣血,積極止血,尤其內鏡下止血至關重要.
목적 탐토경내경역행이담관조영술(ERCP)취석병발상소화도출혈적위험인소급방치방법.방법 회고성분석2014년1월지2014년12월재환남의학원부속익기산의원접수ERCP환자적림상자료,수집가능여ERCP취석술지발출혈유관적위험인소진행단인소화다인소분석,심조ERCP취석술지발출혈적독립위험인소.결과 부합입조표준자383례,남157례、녀226례,년령최소19세,최대88세.병발소화도출혈환자41례(10.7％),술중출혈27례(7.0％),술후출혈14례(3.7％);기중경도출혈28례,중도출혈9례(4례위분문점막시렬),중도출혈4례.환자균전유출원,무일예외과치료급사망.단인소분석발현아사필림/경록필격뢰편복약사、담관염、거대게실급게실내유두위ERCP취석술지발출혈적위험인소(P＜0.05).다인소분석현시담관염(OR=4.125,95％ CI:1.306～ 13.031,P＜0.05)、아사필림/경록필격뢰편복약사(OR=10.220,95％ CI:2.997～34.853,P＜0.01)급게실내유두(OR=14.064,95％ CI:1.888 ～ 104.762,P＜0.05)위ERCP취석술지발출혈적독립위험인소.결론 담관염、아사필림/경록필격뢰편복약사급게실내유두사ERCP취석환자병발상소화도지발출혈적풍험증가.여발생출혈,적겁지혈,우기내경하지혈지관중요.
Objective To investigate the risk factors and prevention of the ERCP-related upper gastrointestinal bleeding in patients with choledocholithiasis.Methods The clinical data of 678 patients who received ERCP in Yijishan Hospital of Wannan Medical College between January 2014 and December 2014 were reviewed.Univariate and multivariate analyses were performed to define the independent risk factor(s) for delayed hemorrhage following ERCP.Results A total of 383 patients,in whom 157 were males and 226 were females,the age ranged from 19 to 88 years,were recruited to the study.ERCP-related upper gastrointestinal bleeding occurred in 41 patients(10.7％),intraoperative bleeding occurred in 27(7.0％) and postoperative hemorrhage in 14 (3.7％).Twenty-eight cases were mild bleeding,9 moderate (4 caused by laceration of the cardiac mucosa) and 4 were severe bleeding.All patients recovered and were discharged,and no death occurred.No single case required surgical conversion.Univariate analysis revealed that cholangitis,medical history of aspirin/clopidogrel,giant diverticulum and the major papilla inside the diverticulum were risk factors for delayed hemorrhage following ERCP (P ＜ 0.05).Multivariate analysis indicated that independent risk factors were associated with cholangitis (OR =4.125,95％ CI:1.306-13.031,P ＜ 0.05),medical history of aspirin/clopidogrel (OR =10.220,95％ CI:2.997-34.853,P ＜ 0.01) and major papilla occurred inside the diverticulum(OR =14.064,95％ CI:1.888-104.762,P ＜ 0.05).Conclusion Cholangitis,medical history of aspirin/clopidogrel and major papilla at the diverticulum may increase the risks for upper gastrointestinal bleeding in ERCP in patients with choledocholithiasis.However,the hemorrhage should be actively managed,especially in endoscopy,once the bleeding occurs.
