本文選題：ERCP + PEP��； 參考：《山西醫(yī)科大學》2014年碩士論文

【摘要】：目的探討ERCP術(shù)后并發(fā)胰腺炎的危險因素，并在研究結(jié)果基礎(chǔ)上結(jié)合文獻資料，提出ERCP術(shù)后胰腺炎的有效預(yù)防措施。 方法收集2010年10月至2013年7月于山西醫(yī)科大學第一附屬醫(yī)院住院行ERCP檢查或治療的168例患者的住院資料。按一定入選和排除標準篩選資料，對符合標準的病例先采用單因素分析方法分別分析患者性別、年齡、肥胖、黃疸、麻醉方式、插管次數(shù)、胰管顯影次數(shù)、乳頭括約肌功能障礙（SOD）、乳頭括約肌切開（EST）、鼻膽管引流（ENBD）、膽管支架置入等因素與ERCP術(shù)后并發(fā)胰腺炎的關(guān)系。對單因素分析結(jié)果中有統(tǒng)計學意義的因素進行多因素非條件Logistic回歸分析，進一步篩選出ERCP術(shù)后胰腺炎的獨立危險因素。 結(jié)果收集到的168例患者中有153例符合入選標準，不符合排除標準。153例患者中發(fā)生ERCP術(shù)后胰腺炎患者有19例，胰腺炎發(fā)生率為12.42%。單因素分析結(jié)果顯示在所選擇的25個因素中有9個因素有統(tǒng)計學意義，分別為性別（女性）、年齡（＜60歲）、胰腺炎史、乳頭括約肌功能障礙（SOD）、插管次數(shù)（≥3）、胰管插管、胰管顯影、注射造影劑次數(shù)（＞2）、鼻膽管引流。將有統(tǒng)計意義因素行多因素非條件Logistic回歸分析，最終篩選出4個變量，其中女性（OR：4.240，95%CI：0.797-22.545）、乳頭括約肌功能障礙（OR：5.715，95%CI：0.988-33.052）、多次插管為（OR：8.540，，95%CI：1.746-41.761）ERCP術(shù)后胰腺炎的獨立危險因素，而鼻膽管引流（OR：0.234，95%CI：0.058-0.947）為ERCP術(shù)后胰腺炎的保護因素。ERCP術(shù)后胰腺炎的預(yù)防包括患者的選擇，內(nèi)鏡技術(shù)和藥物預(yù)防，嚴格掌握ERCP適應(yīng)癥與禁忌癥，術(shù)前對患者進行風險評估，術(shù)中操作輕柔仔細，必要時請上級專家指導(dǎo)，術(shù)后留置鼻膽管引流，預(yù)防性應(yīng)用生長抑素、奧曲肽、抗生素等藥物可有效預(yù)防ERCP術(shù)后胰腺炎的發(fā)生。 結(jié)論女性、乳頭括約肌功能障礙、多次插管是ERCP術(shù)后胰腺炎的高危因素，而鼻膽管引流可預(yù)防ERCP術(shù)后胰腺炎的發(fā)生。嚴格掌握ERCP適應(yīng)癥與禁忌癥，必要時留置鼻膽管引流以及預(yù)防性應(yīng)用生長抑素等藥物可有效預(yù)防ERCP術(shù)后胰腺炎的發(fā)生。
[Abstract]:Objective to explore the risk factors of pancreatitis after ERCP and to provide effective preventive measures for pancreatitis after ERCP.
Methods the data of 168 patients who were hospitalized at the First Affiliated Hospital of Shanxi Medical University from October 2010 to July 2013 were collected from 168 patients who were examined or treated. According to the selected and excluded criteria, a single factor analysis was used to analyze the sex, age, obesity, jaundice, anesthesia, intubation and intubation. The number of times, the number of pancreatic duct development, the sphincter sphincter dysfunction (SOD), the sphincter sphincter (EST), the nasal bile duct drainage (ENBD), the stent placement of the bile duct and other factors associated with pancreatitis after ERCP. The multivariate non conditional Logistic regression analysis was carried out on the statistical factors of the single factor analysis, and the ERCP operation was further screened. Independent risk factors for post pancreatitis.
Results of the 168 patients, 153 of the 168 patients met the criteria for admission. There were 19 cases of post ERCP pancreatitis in the patients who did not meet the exclusion criteria. The incidence of pancreatitis was 12.42%. single factor analysis. The results showed that 9 of the 25 factors selected were statistically significant, namely, sex (female), age (60 years old), and pancreas The history of mastitis, sphincter dysfunction (SOD), intubation times (> 3), pancreatic duct intubation, pancreatic duct development, injection of contrast media (> 2), and naso bile duct drainage. The statistical significance factors were analyzed by multiple factors unconditional Logistic regression analysis, and 4 variables were selected, in which women (OR:4.240,95%CI:0.797-22.545) and sphincter dysfunction (O R:5.715,95%CI:0.988-33.052) independent risk factors for pancreatitis after multiple intubation (OR:8.540,95%CI:1.746-41.761) ERCP, and nasal bile duct drainage (OR:0.234,95%CI:0.058-0.947) as a protective factor for post ERCP pancreatitis, the prevention of post operation pancreatitis after ERCP includes patient selection, endoscopic technique and drug prevention, and strict control ERCP indications and contraindications, risk assessment of patients before operation, soft and careful operation during operation, guidance from superior experts when necessary, postoperative retention of nasal bile duct drainage, preventive application of somatostatin, octreotide, antibiotics and other drugs can effectively prevent the onset of post ERCP pancreatitis.
Conclusion female, papillary sphincter dysfunction and multiple intubation are the high risk factors for post ERCP pancreatitis, and nasbd drainage can prevent the occurrence of post ERCP pancreatitis. Strict control of ERCP indications and contraindications, the necessary indwelling nasobiliary drainage and preventive application of growth suppressor can effectively prevent the onset of post ERCP pancreatitis. Birth.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R576

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