儿童经内镜逆行胰胆管造影术后胰腺炎发生的危险因素分析

Risk factors for pancreatitis after endoscopic retrograde cholangiopancreatography in children

摘要:

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.