伍小琼

[摘要] 目的 分析总结内镜下逆行胰胆管造影（ERCP）术后并发急性胰腺炎的危险因素。 方法 回顾性分析380例行ERCP检查或治疗的患者的临床资料，利用统计学方法分析并发急性胰腺炎的危险因素。 结果 ERCP术后并发急性胰腺炎26例，发病率为6.84%，单因素分析证实女性、年龄<55岁、既往有胰腺炎病史、反复插管、导丝多次进入、过度电凝切开（超过乳头长度60%）、胰管显影、非选择性高压注射造影与急性胰腺炎发生有关（P<0.05），而乳头括约肌切开、胆管扩张无明显相关性（P>0.05）；多因素Logistic回归分析提示反复插管、胰管显影、非选择性高压注射造影、过度电凝切开是急性胰腺炎的危险因素。 结论 反复插管、胰管显影、非选择性高压注射造影、过度电凝切开是ERCP术后并发急性胰腺炎的危险因素，可试图通过评估和控制这些危险因素降低ERCP术后急性胰腺炎的发生率。

[关键词] 内镜下逆行胰胆管造影；急性胰腺炎；危险因素

[中图分类号] R576 [文献标识码] A [文章编号] 1674-4721（2014）04（b）-0034-03

[Abstract] Objective To analyze the risk factors for acute pancreatitis after endoscopic retrograde cholangiopancreatography （ERCP）.Methods Clinical data of 380 cases of ERCP examination or treatment was retrospectively analyzed，risk factors for acute pancreatitis was analyzed by statistical methods.Results 26 cases were acute pancreatitis after ERCP，the rate was 6.84%，univariate analysis showed that women，age < 55 years，previous history of pancreatitis，repeated intubation，wire multiple entry，excessive coagulation cut （more than 60% of the length of the nipple），pancreatic duct，non-selective high-pressure injection was correlated to the occurrence of acute pancreatitis （P<0.05）；while the sphincterotomy，bile duct dilatation had no correlation （P>0.05）.Logistic regression analysis showed that repeated intubation，pancreatic duct，non-selective high-pressure injection，excessive coagulation cut were the risk factors for acute pancreatitis.Conclusion Repeated intubation，pancreatic duct，non-selective high-pressure injection，excessive coagulation cut are the mian risk factors for acute pancreatitis after ERCP，may attempt to assess and control these risk factors to reduce acute pancreatitis after ERCP rate.

[Key words] Endoscopic retrograde cholangiopancreatography；Acute pancreatitis；Risk factors

内镜技术是近20年来高速发展的医疗技术，内镜下逆行胰胆管造影（endoscopic retrograde cholangiopancreatography，ERCP）已成为胰胆管疾病的诊断金标准，并且在ERCP基础上十二指肠乳头括约肌切开术、胆总管取石术、内镜下鼻胆管引流术、胆汁内引流术等治疗已广泛应用于临床[1]。但ERCP属于侵入性操作，作为ERCP最常见的严重并发症，急性胰腺炎将导致患者住院时间延长、费用增加、身心负担加重，严重者甚至危及生命。尽管消化内镜器械不断改进优化，医师操作技能日趋熟练和进步，但许多学者发现急性胰腺炎发生率仍未明显下降，因此，本文回顾性分析在我科进行ERCP检查或治疗的患者的临床资料，探讨发生急性胰腺炎的危险因素，以期为降低ERCP术后急性胰腺炎的发生率提供理论基础。……