| Objective:To investigate the risk factors and protective factors of pancreatitis after ERCP,and to provide evidence for clinical prevention.Methods:Clinical data of 298 cases with ERCP in department of Gastroenterology of Changde First People’s Hospital in Hunan from Jan 2015 to Aug 2016 were retrospectively analyzed.Among them 27 patients were with PEP,and the incidence was 9.06%.General information and clinical data were recorded,including age,gender,hypertension,history of PEP,suspected sphincter of Oddi dysfunction,chronic pancreatitis,disease,recurrent choledocholithiasis and pancreatitis,treatment of jaundice / diagnosis of ERCP,the number of pancreatic duct,pancreatic duct guidewire insertion times,pancreatic duct injection of contrast agent,pre-cut,whether the prevention of drug use,whether endoscopic nasobiliary drainage,pancreatic duct stent.Risk factors and protective factors of PEP were analyzed.(1)Single factor analysis showed that: female less than 60 years Oddi sphincter dysfunctionpatients with PEP,patients with chronic pancreatitis,patients with recurrent pancreatitis,jaundice patients with multiple intubation patients with multiple entry into the pancreatic duct multiple development of pancreatic duct total pancreatic duct development was 30.3%,which was significantly higher than that of patients without pancreatic duct development,and the difference was statistically significant(P< 0.05);The incidence of abdominal pain was 33.3%,and the incidence rate of abdominal pain was not significant(6.0%),and the difference was statistically significant(P< 0.05);The incidence of patients treated with EST was 9.2%,and the incidence of patients without EST was 8.9%,and the difference was not statistically significant(P> 0.05);The incidence of patients with biliary stent placement was 17.9%,which was significantly higher than that of patients without stent placement(3.3%),and the difference was statistically significant(P< 0.05).The incidence of patients with preventive medication was 2.4%,which was significantly lower than that of patients without preventive medication(11.5%),and the difference was statistically significant(P< 0.05);The incidence of pancreatic stent implantation was 0,which was significantly lower than that of patients without pancreatic duct stent implantation(10.4%),and the difference was statistically significant(P< 0.05);The incidence rate of patients with endoscopic naso biliary drainage was 0,which was significantly lower than that of patients who were not treated with endoscopic naso biliary drainage(10.5%),and the difference was statistically significant(P< 0.05).(2)Multivariate analysis showed that: Female,age < 60 years,sphincter of Oddi dysfunction,a history of PEP,with a history of chronic pancreatitis,with a history of recurrent pancreatitis,multiple intubation,pancreatic duct multidevelopment,papillary sphincter precutting,guidewire repeatedly into the pancreatic duct and jaundice were the risk factors of PEP(R=1.981,8.318,4.172,4.835,3.921,3.795,3.961,4.402,2.994,3.045,1.396);Prophylactic use of drugs,insertion of pancreatic duct stents,and endoscopic naso biliary drainage were the protective factors for PEP(R=0.718,0.505,0.611).Conclusion:The influencing factors of patients with acute pancreatitis after ERCP included age,female,history of chronic pancreatitis,PEP history,Oddi sphincter dysfunction.The factors affecting the operation of acute pancreatitis after ERCP include multiple intubation,multiple entry of the guide wire into the pancreatic duct,multiple development of the pancreatic duct.The use of preventive medicine,pancreatic stent implantation,endoscopicnaso biliary drainage can effectively prevent the occurrence of postoperative pancreatitis ERCP. |
