摘要
目的探讨肝硬化合并胆胰疾病病人接受ERCP术的危险性，以及相应的应对措施。方法回顾性分析1992年1月至2008年3月该科收治的胆胰疾病合并肝硬化病人174例，其中成功接受ERCP术156例（观察组），及随机抽取同期接受ERCP术诊治且无肝硬化病史的胆胰疾病150例（对照组），对比分析ERCP操作时间、术中术后并发症发生情况，以及病死率。结果观察组中23例（14．7％）为Child—PughA级，77例（49．4％）为Child—PughB级，56例（35．9％）为Child—PughC级；22例（14．1％）出现1种或1种以上并发症，以出血、诱发感染、术后胰腺炎为常见并发症；病死率1．28％（2／156）；在ERCP操作时间和ERCP术后出血率上两组间存在显著性差异。结论胆胰疾病合并肝硬化病人ERCP诊疗过程中的耐受程度良好；Child—Pugh分级是决定内镜治疗方式和判断预后的重要参考指标；对肝硬化失代偿者行微创治疗仍具有一定风险，严重并发症主要为术后出血，采取有效的预防和止血措施，有更多的肝硬化胆胰疾病病人仍能受益于内镜治疗。
Objective To review the risk factors of ERCP in biliary or pancreatic diseases with cirrhosis to find appropriate strategies. Methods In this study, we reviewed 174 cases of biliary and pancreatic diseases with cirrhosis in a public hospital in China from January 1992 to March 2008, and retrospectively evaluated a group of symptomatic cirrhotic （n= 156,156/174） and non-cirrhotic （n= 150） patients subjected to ERCP. The groups were compared for ERCP time, trans-ERCP and post- ERCP complications, mortality rates. Results Twenty-three （14.7%） of the patients of the cirrho- sis-ERCP group were classified as Child-Pugh A, seventy-seven （49.4% ） Child-Pugh B, and fifty-six （35.9% ） Child Pugh C. Complications happened in twenty-two （14. 1% ） of EG, including bleeding, infection, pancreatitis. And differences between the two groups included ERCP time and the occur rence of post ERCP bleeding. Conclusion Patients with cirrhosis have considerable tolerance during ERCP to treat their biliary tract or pancreatic diseases. Child Pugh classification is the determinative factor of ERCP treatment plans and the most important predictor of outcome. The main server complication was Post ERCP bleeding. We had satisfied curative effects by endoscopic injection homeostasis and oral applications of thrombinum.
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2009年第9期647-650,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
肝硬化
ERCP
并发症
Liver cirrhosis
ERCP
Complication
