目的 探讨经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography, ERCP）在儿童患者应用中术后胰腺炎（post-ERCP pancreatitis, PEP）发生的危险因素。 方法 回顾性分析2013年9月—2023年9月在昆明医科大学第二附属医院消化内镜中心因胆胰疾病接受ERCP诊疗的66例年龄≤16岁患儿的临床资料，分析PEP的发生率及相关影响因素。 结果 66例患儿共进行ERCP 78例次，诊断性ERCP 5例次，治疗性ERCP 69例次，操作失败4例次，ERCP操作成功率为95%（74/78）。术后共有17例次发生胰腺炎，发生率为22%。PEP组患儿术前胆红素正常比例、术中导丝探插入胰管比例高于非PEP组（P<0.05）。多因素logistic回归分析显示，导丝探插入胰管为儿童ERCP PEP发生的危险因素（P<0.05）。 结论 随着ERCP在儿童胆胰疾病中应用逐渐增多，术中应选择合适的插管技术，避免导丝盲目进入胰管，减少PEP的发生。
Abstract
Objective To investigate the application of endoscopic retrograde cholangiopancreatography (ERCP) in children and the risk factors for post-ERCP pancreatitis (PEP). Methods A retrospective analysis was conducted on the clinical data of 66 children, aged ≤16 years, who underwent ERCP for pancreaticobiliary diseases at the Gastrointestinal Endoscopy Center of the Second Affiliated Hospital of Kunming Medical University from September 2013 to September 2023. The incidence rate of PEP and the risk factors for the development of PEP were analyzed. Results A total of 78 ERCP procedures were performed on 66 children, with 5 diagnostic ERCPs, 69 therapeutic ERCPs, and 4 failed procedures. The success rate of ERCP operations was 95% (74/78). There were 17 cases of PEP in total, with an incidence rate of 22%. In the PEP group, the proportion of children with normal preoperative bilirubin and the proportion of guidewire insertion into the pancreatic duct during surgery were higher than in the non-PEP group (P<0.05). The multivariate logistic regression analysis showed that guidewire insertion into the pancreatic duct was an independent risk factor for PEP (P<0.05). Conclusions With the increasing application of ERCP in children with pancreaticobiliary diseases, it is important to select an appropriate intubation technique during surgery to avoid blindly entering the guidewire into the pancreatic duct and reduce the occurrence of PEP.
关键词
经内镜逆行胰胆管造影术 /
胆胰疾病 /
术后胰腺炎 /
危险因素 /
儿童
Key words
Endoscopic retrograde cholangiopancreatography /
Pancreaticobiliary disease /
Post-ERCP pancreatitis /
Risk factor /
Child
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参考文献
1 McCune WS, Shorb PE, Moscovitz H. Endoscopic cannulation of the ampulla of vater: a preliminary report[J]. Ann Surg, 1968, 167(5): 752-756. PMID: 5646296. PMCID: PMC1387128. DOI: 10.1097/00000658-196805000-00013.
2 Waye JD. Endoscopic retrograde cholangiopancreatography in the infant[J]. Am J Gastroenterol, 1976, 65(5): 461-463. PMID: 949055.
3 Dumonceau JM, Kapral C, Aabakken L, et al. ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) guideline[J]. Endoscopy, 2020, 52(2): 127-149. PMID: 31863440. DOI: 10.1055/a-1075-4080.
4 ?vitsland TL, Aabakken L. Endoscopic retrograde cholangiopancreatography in infants and children[J]. Endosc Int Open, 2021, 9(3): E292-E296. PMID: 33655024. PMCID: PMC7892276. DOI: 10.1055/a-1337-2212.
5 Perera KDR, Nawarathne NMM, Samarawickrama VT, et al. Endoscopic retrograde cholangiopancreatography in children: feasibility, success, and safety with standard adult endoscopes and accessories[J]. Pediatr Gastroenterol Hepatol Nutr, 2022, 25(5): 406-412. PMID: 36148288. PMCID: PMC9482827. DOI: 10.5223/pghn.2022.25.5.406.
6 Asenov Y, Ak?n M, Cantez S, et al. Endoscopic retrograde cholangiopancreatography in children: retrospective series with a long-term follow-up and literature review[J]. Turk J Gastroenterol, 2019, 30(2): 192-197. PMID: 30459128. PMCID: PMC6408168. DOI: 10.5152/tjg.2018.18165.
7 Mercier C, Pioche M, Albuisson E, et al. Safety of endoscopic retrograde cholangiopancreatography in the pediatric population: a multicenter study[J]. Endoscopy, 2021, 53(6): 586-594. PMID: 32599632. DOI: 10.1055/a-1209-0155.
8 Prasil P, Laberge JM, Barkun A, et al. Endoscopic retrograde cholangiopancreatography in children: a surgeon's perspective[J]. J Pediatr Surg, 2001, 36(5): 733-735. PMID: 11329577. DOI: 10.1053/jpsu.2001.22948.
9 Tryliskyy Y, Bryce GJ. Post-ERCP pancreatitis: pathophysiology, early identification and risk stratification[J]. Adv Clin Exp Med, 2018, 27(1): 149-154. PMID: 29521055. DOI: 10.17219/acem/66773.
10 时秀梅, 彭海峰. 内镜逆行胰胆管造影术后胰腺炎的发病机制[J]. 内蒙古中医药, 2010, 29(18): 63-64. DOI: 10.3969/j.issn.1006-0979.2010.18.074.
11 Cahyadi O, Tehami N, de-Madaria E, et al. Post-ERCP pancreatitis: prevention, diagnosis and management[J]. Medicina (Kaunas), 2022, 58(9): 1261. PMID: 36143938. PMCID: PMC9502657. DOI: 10.3390/medicina58091261.
12 朱荣慧, 许业涛, 许金芳, 等. 放置胆管支架与儿童ERCP术后胰腺炎的关系[J]. 武警医学, 2022, 33(2): 98-101. DOI: 10.3969/j.issn.1004-3594.2022.02.002.
13 Troendle DM, Abraham O, Huang R, et al. Factors associated with post-ERCP pancreatitis and the effect of pancreatic duct stenting in a pediatric population[J]. Gastrointest Endosc, 2015, 81(6): 1408-1416. PMID: 25686874. DOI: 10.1016/j.gie.2014.11.022.
14 Dumonceau JM, Andriulli A, Elmunzer BJ, et al. Prophylaxis of post-ERCP pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) guideline—updated June 2014[J]. Endoscopy, 2014, 46(9): 799-815. PMID: 25148137. DOI: 10.1055/s-0034-1377875.
15 Martínez-Moneo E, Cárdenas-Jaén K, Fernández-Laso AB, et al. Statin consumption and risk of post-endoscopic retrograde cholangiopancreatography pancreatitis[J]. Pancreatology, 2020, 20(5): 801-805. PMID: 32448748. DOI: 10.1016/j.pan.2020.05.002.
16 李媛媛, 李国华, 陈幼祥, 等. 导丝引导插管对ERCP术后胰腺炎的影响[J]. 南昌大学学报（医学版）, 2011, 51(10): 62-64. DOI: 10.3969/j.issn.1000-2294.2011.10.018.
17 秦学潜, 吴钢. 内窥镜下逆行胰胆管造影术中导丝进入胰管与术后高淀粉酶血症的相关性[J]. 安徽医药, 2020, 24(7): 1321-1324. DOI: 10.3969/j.issn.1009-6469.2020.07.013.
18 Palomera-Tejeda E, Shah MP, Attar BM, et al. Pharmacological and endoscopic interventions for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis[J]. Gastroenterology Res, 2023, 16(3): 149-156. PMID: 37351082. PMCID: PMC10284647. DOI: 10.14740/gr1620.
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