肝硬化患者经内镜逆行胰胆管造影治疗的安全性分析

武聚山; 李磊; 宋艳明; 封莉; 李冰

doi:10.3969/j.issn.1001-5256.2014.12.009

肝硬化患者经内镜逆行胰胆管造影治疗的安全性分析

DOI: 10.3969/j.issn.1001-5256.2014.12.009

1. 首都医科大学附属北京佑安医院肝胆外科
2. 首都医科大学附属北京佑安医院肝病消化中心

基金项目:

北京市卫生系统高层次卫生技术人才培养计划(学科骨干)(2013-3-072)；

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2014-06-11
- 出版日期: 2014-12-20

Comparative study on safety of endoscopic retrograde cholangiopancreatography in patients with cirrhosis

Department of Hepatobiliary Surgery, Beijing You'an Hospital, Capital Medical University

Research funding:

摘要

摘要:
目的探讨肝硬化患者接受经内镜逆行胰胆管造影（ERCP）治疗的安全性。方法回顾性分析2010年1月至2013年11月在北京佑安医院接受ERCP治疗的347例患者的临床资料,将所有患者分为无肝病组（258例）、慢性肝炎组（40例）和肝硬化组（49例）。采用单因素方差分析和Kruskal-Wallis H分析3组患者ERCP术后ALT、AST、白蛋白（Alb）、TBil、白细胞（WBC）、中性粒细胞百分数、血淀粉酶的变化,χ2检验分析ERCP术后高淀粉酶血症、急性胰腺炎、感染、出血和穿孔等并发症发生率和疾病诊断的分布。结果肝硬化组患者术前血清Alb、ALT、AST水平低于无肝病组和慢性肝炎组,差异有统计学意义（F=3.68,P=0.028;H=14.03,P=0.001和H=8.00,P=0.018）。肝硬化组患者术后TBil水平高于其他2组,差异有统计学意义（H=6.69,P=0.035）。44.9%（22/49）的肝硬化组患者术后3 d的AST和TBil高于术前,在3组中的比例最高。肝硬化组患者术后1 d中性粒细胞百分数为（73.9±12.7）%,与无肝病组（74.8±11.0）%相近,...
- 肝硬化 /
- 胰胆管造影术,内窥镜逆行 /
- 手术后并发症 /
- 高淀粉酶血症
Abstract:
Objective To evaluate the safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with cirrhosis. Methods A retrospective analysis was performed on the clinical data of 347 patients who were admitted to Beijing You'an Hospital and received ERCP from January 2010 to November 2013. Patients were divided into three groups: patients without liver diseases (n = 258) , patients with chronic hepatitis (n = 40) , and patients with cirrhosis (n = 49) . One-way ANOVA or Kruskal-Wallis H test was performed to compare changes in alanine aminotransferase (ALT) , aspartate transaminase (AST) , albumin (Alb) , total bilirubin (TBil) , white blood cells (WBC) , percentage of neutrophils (NEUT) , and serum amylase between the three groups of patients after ERCP. The incidence rates of complications, including hyperamylasemia, acute pancreatitis, infection, hemorrhage, and perforation, and distribution of disease spectrum diagnosis the changes in liver function and blood amylase after ERCP were analyzed compared between the three groups using chi-square test. Results Patients with cirrhosis had significantly lower levels of serum Alb, ALT, and AST than patients in the other two groups before ERCP (H = 3. 68, P = 0. 028; H = 14. 03, P = 0. 001, and H = 8. 00, P = 0. 018, respectively) . After ERCP, the TBil level was significantly higher in the cirrhosis group than in the other two groups (H = 6. 69, P = 0. 035) . Compared with the serum levels of AST and TBil before ERCP, 44. 9% (22 /49) of patients with cirrhosis had higher levels of AST and TBil 3 days after ERCP, the incidence of which was the highest among all three groups. The percentage of NEUT 1 day after ERCP in patients with cirrhosis was 73. 9% ± 12. 7%, which was similar to that in patients without liver diseases (74. 8% ± 11. 0%) and higher than that in patients with chronic hepatitis; the difference between the three groups was statistically significant (H = 7. 31, P = 0. 026) . Although no significant difference in the percentage of patients who had > 80%NEUT 3 days after ERCP was observed between the three groups, the percentage was the highest in the group of patients with cirrhosis (18. 4%, 9 /258) . The incidence rate of hyperamylasemia 24 hours after ERCP 24 h was significantly higher in patients with cirrhosis (53. 1%) than in patients without liver diseases (31. 8%) or with chronic hepatitis (40. 0%) (χ2= 8. 48, P = 0. 014) . The overall complication rates in patients with cirrhosis (18. 4%) was significantly higher than that in patients without liver diseases (8. 1%) or with chronic hepatitis (7. 5%) (χ2= 26. 73, P < 0. 001) . Conclusion ERCP is a safe and effective therapeutic intervention and well tolerated by patients with cirrhosis. Hyperamylasemia should be closely monitored after ERCP.
- liver cirrhosis /
- cholangiopancreatography, endoscopic retrograde /
- postoperative complications /
- hyperamylasemia

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参考文献(19)

[1]CHAWLA A, PUTHUMANA L, THULUVATH PJ.Autonomic dysfunction and cholelithiasis in patients with cirrhosis[J].Dig Dis Sci, 2001, 46 (3) :495-498.

[2]CONTE D, BARISANI D, MANDELLI C, et al.Cholelithiasis in cirrhosis:analysis of 500 cases[J].Am J Gastroenterol, 1991, 86 (11) :1629-1632.

[3]HU LH, LIAO Z, GAO R, et al.Comparison of complication and success rates of endoscopic retrograde cholangiopancreatography between 2001 and 2007:a retrospective report from Changhai hospital[J].Chin J Dig Endosc, 2009, 26 (5) :248-252. (in Chinese) 胡良皞, 廖专, 高瑞, 等.长海医院2001年与2007年ERCP成功率和并发症比较研究[J].中华消化内镜杂志, 2009, 26 (5) :248-252.

[4]TESTONI PA.Why the incidence of post-ERCP pancreatitis varies considerably?Factors affecting the diagnosis and the incidence of this complication[J].JOP, 2002, 3 (6) :195-201.

[5]PERMEY P, BERTHIER E, PAGEAUX GP, et al.Are drugs a risk factor of post-ERCP pancreatitis?[J].Gastrointest Endosc, 2003, 58 (5) :696-700.

[6] ZHOU YF, ZAHNG X, ZAHNG XF, et al.ERCP in patients with liver cirrhosis:an analysis of 156 cases[J].Chin J Hepatobiliary Surg, 2009, 15 (9) :647-650. (in Chinese) 周益峰, 张啸, 张筱凤, 等.156例合并肝硬化的胆胰疾患内镜临床分析[J].中华肝胆外科杂志, 2009, 15 (9) :647-650.

[7]YANG GY, TAO Y.Mechanism of hyperamylasemia in patients with liver cirrhosis[J].Int J Lab Med, 1985, 5 (1) :35. (in Chinese) 杨根远, 陶原.肝硬化患者高淀粉酶血症的机理[J].国际检验医学杂志, 1985, 5 (1) :35.

[8] HE Y, YUAN FY.Diagnostic relationship between liver and systemic disease[M].Beijing:People's Military Medical Press, 2002:122-123. (in Chinese) 何云, 袁凤仪.肝脏与全身系统疾病诊断关系[M].北京:人民军医出版社, 2002:122-123.

[9]LI XP, WANG JB, SUN KK.Safety of balloon dilation of the sphincter of Oddi for removal of common bile duct stones in patients with liver cirrhosis[J].Chin J Dig Endosc, 2007, 24 (3) :215-217. (in Chinese) 李小平, 王金波, 孙柯科.Oddi括约肌气囊扩张取石治疗肝硬化合并胆总管结石的安全性探讨[J].中华消化内镜杂志, 2007, 24 (3) :215-217.

[10]CHIJIIWA K, KOZAKI N, NAITO T, et al.Treatment of choice for choledocholithiasis in patients with acute obstructive suppurative cholangitis and liver cirrhosis[J].Am J Surg, 1995, 170 (4) :356-360.

[11]PARK DH, KIM MH, LEE SK, et al.Endoscopic sphincterotomy vs.endoscopic papillary balloon dilation for choledocholithiasis in patients with liver cirrhosis and coagulopathy[J].Gastrointest Endosc, 2004, 60 (2) :180-185.

[12]FERREIRA LE, BARON TH.Post-sphincterotomy bleeding:who, what, when and how[J].Am J Gastroenterol, 2007, 102 (12) :2850-2858.

[13]LI SP, XUE DQ, DU HW, et al.Endoscopic therapy for choledocholithiasis with liver cirrhosis and esophagogastric varices:an analysis of 52 cases[J].World Chin J Dig, 2012, 20 (32) :3154-3158.李素萍, 薛迪强, 杜宏伟, 等.内镜下治疗肝硬化食管胃底静脉曲张并胆总管结石52例[J].世界华人消化杂志, 2012, 20 (32) :3154-3158.

[14]LINGHU EQ, YANG YS, LI ZQ, et al.ERCP for patients with gastroesophageal varices combined with pancreatobiliary diseases[J/CD].Chin J Laparoscopic Surgery:Electronic Edition, 2011, 4 (5) :362-364. (in Chinese) 令狐恩强, 杨云生, 李志群, 等.食管胃静脉曲张患者伴胆胰疾病内镜下治疗的研究[J/CD].中华腔镜外科杂志:电子版, 2011, 4 (5) :362-364.

[15] LOU SM, ZHANG X, ZHANG XF.Comparison of two endoscopic therapies for liver cirrhosis with common bile duct stones[J].Zhejiang Med J, 2009, 31 (9) :1279-1280. (in Chinese) 楼颂梅, 张啸, 张筱凤.肝硬化并胆总管结石两种内镜治疗方案疗效的比较[J].浙江医学, 2009, 31 (9) :1279-1280.

[16]WU ZQ, FAN ZN, WANG M.Value of duodenoscopy in the treatment of biliary and pancreatic diseases complicated with hepatocirrhosis[J].Chin J Mini Invas Surg, 2011, 11 (8) :700-703. (in Chinese) 吴正奇, 范志宁, 王敏.十二指肠镜在治疗胆胰疾病合并肝硬变中的价值[J].中国微创外科杂志, 2011, 11 (8) :700-703.

[17]XU L, WANG F, ZHANG YF, et al.Efficacy of endoscopic sphincterotomy versus laparoscopic common bile duct exploration in treatment of common bile duct stones with liver cirrhosis[J].J Surg Concepts Pract, 2011, 16 (6) :587-588. (in Chinese) 徐琳, 王峰, 张宇飞, 等.内镜下乳头切开与开腹胆道探查治疗胆总管结石合并肝硬化的疗效比较[J].外科理论与实践, 2011, 16 (6) :587-588.

[18]MOREIRA VF, ARRIBAS R, SANROMAN AL, et al.Choledocholithiasis in cirrhotic patients:is endoscopic sphincterotomy the safest choice?[J].Am J Gastroenterol, 1991, 86 (8) :1006-1010.

[19]ZHANG Y, LIU D, MA Q, et al.Factors influencing the prevalence of gallstones in liver cirrhosis[J].J Gastroenterol Hepatol, 2006, 21 (9) :1455-1458.

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