Complications of endoscopic biliary sphincterotomy
Complications of endoscopic biliary sphincterotomy
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DOI：
10.1056/nejm199609263351301
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发表时间：
1996-09-26
影响因子：
158.5
通讯作者：
Pheley, AM
中科院分区：
文献类型：
--
作者：
Freeman, ML;Nelson, DB;Pheley, AM
内镜下括约肌切开术常用于清除胆管结石和治疗其他疾病。我们前瞻性地调查了该手术并发症的危险因素及其结果。方法我们研究了1992年至1994年在美国和加拿大的17家机构接受内镜下胆道括约肌切开术的连续患者在30天内发生的并发症。（9.8%）有并发症，包括127例胰腺炎（5.4%）和48例出血（2.0%）。30天内有55例死亡，其中10例死亡与手术直接或间接相关。在多变量分析中确定的五个重要的并发症风险因素中，两个是患者的特征（怀疑Oddi括约肌功能障碍是手术的指征和肝硬化的存在），3例与内窥镜技术有关。（胆管插管困难，通过“预切"括约肌切开术进入胆管，以及使用经皮-内窥镜联合手术）。并发症的总体风险与患者的年龄、并存疾病的数量或胆管直径无关。当手术适应症为疑似Oddi括约肌功能障碍时，并发症发生率最高（21.7%），而当适应症为腹腔镜胆囊切除术后30天内取出胆管结石时，并发症发生率最低（4.9%）。与较少手术者相比，每周进行一次以上括约肌切开术的内镜医生并发症发生率较低（8.4%对11.1%，P=0.03）结论内镜下胆道括约肌切开术后并发症的发生率在不同情况下有很大差异，主要与手术适应证和内镜技术有关，而不是患者的年龄或一般医疗状况。
Background Endoscopic sphincterotomy is commonly used to remove bile-duct stones and to treat other problems. We prospectively investigated risk factors for complications of this procedure and their outcomes.Methods We studied complications that occurred within 30 days of endoscopic biliary sphincterotomy in consecutive patients treated at 17 institutions in the United States and Canada from 1992 through 1994.Results Of 2347 patients, 229 (9.8 percent) had a complication, including pancreatitis in 127 (5.4 percent) and hemorrhage in 48 (2.0 percent). There were 55 deaths from all causes within 30 days; death was directly or indirectly related to the procedure in 10 cases. Of five significant risk factors for complications identified in a multivariate analysis, two were characteristics of the patients (suspected dysfunction of the sphincter of Oddi as an indication for the procedure and the presence of cirrhosis) and three were related to the endoscopic technique (difficulty in cannulating the bile duct, achievement of access to the bile duct by ''precut'' sphincterotomy, and use of a combined percutaneous-endoscopic procedure). The overall risk of complications was not related to the patient's age, the number of coexisting illnesses, or the diameter of the bile duct. The rate of complications was highest when the indication for the procedure was suspected dysfunction of the sphincter of Oddi (21.7 percent) and lowest when the indication was removal of bile-duct stones within 30 days of laparoscopic cholecystectomy (4.9 percent). As compared with those who performed fewer procedures, endoscopists who performed more than one sphincterotomy per week had lower rates of complications (8.4 percent vs. 11.1 percent, P=0.03).Conclusions The rate of complications after endoscopic biliary sphincterotomy can vary widely in different circumstances and is primarily related to the indication for the procedure and to endoscopic technique, rather than to the age or general medical condition of the patient.