ERCP支架植入治疗梗阻性黄疸后并发急性胆囊炎的相关因素分析与防治

摘要

Objective:To analyze the related factors and prevention methods of acute cholecystitis after endoscopic retrograde cholangiopancreatography (ERCP) stent implantation for obstructive jaundice.Methods:The clinical data of 58 patients were collected,then single factor analysis was performed,and multivariate Logistic regression was used to analyze the independent risk factors of acute cholecystitis after operation,the prevention and cure methods were also discussed.Results:Four cases of the obstructive jaundice patients got acute cholecystitis after ERCP stent implantation,and the incidence was 6.90 ％.Multivariate analysis showed that there was a significant correlation between the recurrence of acute calculous cholecystitis and acute cholecystitis (P＜0.01,OR=21.073).One of the 4 patients had relieved symptoms after 1 day of conservative treatment;the other three patients (75％) relieved symptoms after percutaneous transhepatic gallbladder drainage.Conclusion:Improving the awareness and attention of postoperative acute cholecystitis and doing the relevant preventive measures are conducive to reducing the incidence of this complication,once it occurs in time to make a diagnosis and early treatment.%目的:分析内镜下逆行胰胆管造影(ERCP)支架植入术治疗梗阻性黄疸后并发急性胆囊炎的相关因素及其防治方法.方法:选取2014-01～2016-12我院收治的因梗阻性黄疸成功行ERCP支架植入术的患者58例,收集所有患者的临床资料,先进行单因素分析,然后使用多因素Logistic回归分析术后并发急性胆囊炎的独立危险因素,并探讨其防治方法.结果:4例梗阻性黄疸患者在接受ERCP支架植入术后并发急性胆囊炎,其发生率为6.90％.多因素分析结果表明,术前急性结石性胆囊炎反复发作与术后急性胆囊炎的发生存在明显相关性(P＜0.01,OR=21.073).4例患者中1例经过保守治疗1d后症状得到缓解,另外3例(75％)通过经皮经肝胆囊穿刺引流治疗后症状缓解.结论:术前急性结石性胆囊炎反复发作是ERCP支架植入治疗梗阻性黄疸术后并发急性胆囊炎的独立危险因素.在术后急性胆囊炎的治疗上首选保守治疗,若保守治疗无效应及时采用经皮经肝胆囊穿刺引流.提高对术后并发急性胆囊炎的认识及重视,做好相关预防措施有利于降低该并发症的发生率,一旦出现要及时诊断、早期处理.