内镜下逆行胰胆管造影术术后胰腺炎治疗进展

田 园1, 任 利2
1、青海大学
2、青海大学附属医院

摘要


内镜下逆行胰胆管造影术（ERCP）作为诊断和治疗胆胰疾病的重要工具，其术后并发症，尤其是胰腺炎
（post-ERCP pancreatitis，PEP），显著影响了患者的预后和临床应用的安全性。本综述系统分析了PEP的风险因素、
预防措施和管理策略。患者相关因素如性别、年龄及基础疾病对PEP风险有重要影响，而操作相关因素如胰管插管
难度、造影剂使用和Oddi括约肌操作与术后并发症密切相关。此外，乳头解剖学特征被认为是影响操作成功率和术
后并发症的重要因素，针对乳头形态的个性化操作策略可显著优化ERCP结局。预防PEP的药物干预以非甾体抗炎
药为主，强调使用时机和方式对效果的影响。术后管理方面，早期识别、动态监测和多学科协作对改善患者预后具
有重要意义。尽管已有研究为PEP的防治提供了宝贵经验，但多中心、大样本研究仍需进一步开展，以支持标准化
和个性化的临床管理策略。

关键词


逆行胰胆管造影术；胰腺炎；术后管理；综述

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参考


[1]肖茂林，缪林，李全朋.内镜下逆行胰胆管造影

术后胰腺炎相关危险因素分析及对策 %J 中国内镜杂志

[J].2013，19（06）：624-7.

[ 2 ] D U M O N C E A U J M , A N D R I U L L I A ,

ELMUNZER B J, et al. Prophylaxis of post-ERCP

pancreatitis: European Society of Gastrointestinal Endoscopy

(ESGE) Guideline - updated June 2014 [J]. Endoscopy, 2014,

46(9): 799-815.

[3]FREEMAN M L, DISARIO J A, NELSON D B,

et al. Risk factors for post-ERCP pancreatitis: a prospective,

multicenter study [J]. Gastrointestinal endoscopy, 2001, 54(4):

425-34.

[4]COTTON P B, GARROW D A, GALLAGHER J,

et al. Risk factors for complications after ERCP: a multivariate

analysis of 11,497 procedures over 12 years [J]. Gastrointestinal

endoscopy, 2009, 70(1): 80-8.

[5]ELMUNZER B J, SCHEIMAN J M, LEHMAN G

A, et al. A randomized trial of rectal indomethacin to prevent

post-ERCP pancreatitis [J]. The New England journal of

medicine, 2012, 366(15): 1414-22.

[6]CHANDRASEKHARA V, KHASHAB M A,

MUTHUSAMY V R, et al. Adverse events associated with

ERCP [J]. Gastrointestinal endoscopy, 2017, 85(1): 32-47.

[7]LOPERFIDO S, ANGELINI G, BENEDETTI G, et

al. Major early complications from diagnostic and therapeutic

ERCP: a prospective multicenter study [J]. Gastrointestinal

endoscopy, 1998, 48(1): 1-10.

[8]PEERY A F, DELLON E S, LUND J, et al. Burden

of gastrointestinal disease in the United States: 2012 update [J].

Gastroenterology, 2012, 143(5): 1179-87.e3.

[9]TENNER S, BAILLIE J, DEWITT J, et al. American

College of Gastroenterology guideline: management of acute

pancreatitis [J]. The American journal of gastroenterology,

2013, 108(9): 1400-15; 16.

[10]DUMONCEAU J M, ANDRIULLI A, DEVIERE

J, et al. European Society of Gastrointestinal Endoscopy

(ESGE) Guideline: prophylaxis of post-ERCP pancreatitis [J].

Endoscopy, 2010, 42(6): 503-15.

[11]COTTON P B, LEHMAN G, VENNES J, et

al. Endoscopic sphincterotomy complications and their

management: an attempt at consensus [J]. Gastrointestinal

endoscopy, 1991, 37(3): 383-93.

[12]FREEMAN M L, NELSON D B, SHERMAN S, et

al. Complications of endoscopic biliary sphincterotomy [J]. The

New England journal of medicine, 1996, 335(13): 909-18.

[13]FREEMAN M L, GUDA N M. Prevention

of post-ERCP pancreatitis: a comprehensive review [J].

Gastrointestinal endoscopy, 2004, 59(7): 845-64.

[14]ANDRIULLI A, LOPERFIDO S, NAPOLITANO

G, et al. Incidence rates of post-ERCP complications: a

systematic survey of prospective studies [J]. The American

journal of gastroenterology, 2007, 102(8): 1781-8.

[15]TESTONI P A, MARIANI A, AABAKKEN L,

et al. Papillary cannulation and sphincterotomy techniques at

ERCP: European Society of Gastrointestinal Endoscopy (ESGE)

Clinical Guideline [J]. Endoscopy, 2016, 48(7): 657-83.

[16]CHOUDHARY A, BECHTOLD M L, ARIF

M, et al. Pancreatic stents for prophylaxis against postERCP pancreatitis: a meta-analysis and systematic review [J].

Gastrointestinal endoscopy, 2011, 73(2): 275-82.

[17]CROCKETT S D, WANI S, GARDNER T B,

et al. American Gastroenterological Association Institute

Guideline on Initial Management of Acute Pancreatitis [J].

Gastroenterology, 2018, 154(4): 1096-101.

[18]CHENG C L, SHERMAN S, WATKINS

J L, et al. Risk factors for post-ERCP pancreatitis: a

prospective multicenter study [J]. The American journal of

gastroenterology, 2006, 101(1): 139-47.


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