Effect of CO2 cholangiography on post-ERCP cholangitis in patients with unresectable malignant hilar obstruction – a prospective, randomized controlled study
Effect of CO2 cholangiography on post-ERCP cholangitis in patients with unresectable malignant hilar obstruction – a prospective, randomized controlled study
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CO2 胆管造影对不可切除恶性肝门梗阻患者 ERCP 后胆管炎的影响——一项前瞻性、随机对照研究
DOI：
10.3109/00365521.2013.779745
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发表时间：
2013
影响因子：
1.9
通讯作者：
Xuegang Guo
中科院分区：
文献类型：
--
作者：
Rongchun Zhang;Lina Zhao;Zhiguo Liu;Biao;Na Hui;Xiangping Wang;Rui Huang;Hui Luo;D. Fan;Yanglin Pan;Xuegang Guo
摘要背景：空气胆道造影已被用于恶性肝门梗阻的患者，以减少内镜逆行胰胆管造影（ERCP）后的胆管炎。然而，目前仍不清楚二氧化碳是否可以作为此类患者空气胆道造影的替代品。目的：探讨二氧化碳胆道造影对ERCP术后并发症的影响。设计：前瞻性随机对照研究。设置：三级护理转诊中心。患者：将36例II、III或IV型糖尿病患者随机分为CO2组或碘造影剂组（对照组）。干预：通过括约肌切开器注射CO2或碘造影剂进行胆管造影。置入1枚或2枚金属支架。主要观察指标：ERCP术后并发症、ERCP术后住院时间、1个月和1年死亡率。测试结果：CO2组与对照组患者在年龄、性别、症状、肝功能检查、肿瘤来源类型、Bischloride分型等方面差异无统计学意义（p > 0.05）。与单支架置入相比，双支架置入的CO2量更多，手术时间更长（均p < 0.05）。CO2组胆管炎发生率显著低于对照组（5.6% vs. 33.3%，p = 0.04）。ERCP术后平均住院时间CO2组明显短于对照组（P < 0.05）。两组1个月、1年病死率差异无显著性（均P > 0.05）。结论：CO2胆道造影是一种安全的显示肝内胆管的方法，ERCP术后胆管炎发生率低，对肝门部恶性梗阻患者可考虑采用。
Abstract Background: Air cholangiogram has been used in patients with malignant hilar obstruction to reduce cholangitis after endoscopic retrograde cholangiopancreatography (ERCP). However, it still remains unclear whether CO2 could be used as an alternative for air cholangiography in such patients. Objective: To investigate the effect of CO2 cholangiogram on post-ERCP complications. Design: Prospective, randomized controlled study. Setting: Tertiary care referral center. Patients: 36 patients with Bismuth type II, III or IV were randomized into CO2 group or iodine contrast group (control group). Intervention: Cholangiography was performed by injection of either CO2 or iodine contrast through a sphincterotome. One or two metal stents were placed. Main outcome measures: Post-ERCP complications, length of hospital stay after ERCP, 1-month and 1-year mortality. Result: There was no significant difference in age, gender, symptoms, liver function tests, type of tumor origin and Bismuth type between patients in CO2 and contrast groups (p > 0.05). Compared with one-stent placement, more volume of CO2 and longer operation time were observed when performing two-stent placement (both p < 0.05). The rate of cholangitis in CO2 group was significantly lower than that in control group (5.6% vs. 33.3%, p = 0.04). After ERCP, mean hospital stay time was shorter in CO2 group compared with control (p < 0.05). The difference of 1-month and 1-year mortality between two groups was not significant (both p > 0.05). Conclusion: CO2 cholangiogram could be a safe method to visualize intrahepatic bile duct with low incidence of post-ERCP cholangitis, which could be considered for the patients with malignant hilar obstruction.