ERCP乳头切开取石术后胰腺炎影响因素分析
|
摘要
研究背景：自从ERCP技术广泛应用于临床至今已有50余年,对于ERCP术后并发症的研究重点也逐渐从治疗转为预防,因此对于影响ERCP术后胰腺炎发生的危险因素的探讨也越来越深入。既往研究表明,患者本身的因素和操作因素共同影响ERCP术后胰腺炎的发生。
目的：本研究的目的是探讨我中心2003-2011年间因胆总管结石行ERCP乳头切开取石术患者发生ERCP术后胰腺炎(PEP)的影响因素。
方法：搜集我中心2003-2011年398例胆总管结石行ERCP乳头切开取石术患者,对于他们的一般资料和ERCP相关资料进行系统的整理,根据纳入和排除标准,我们仅选取首次行ERCP乳头切开取石术的符合上述纳入标准的胆总管结石患者进入研究,对符合标准并纳入研究的327例病例的资料进行数据分析。数据分析运用SPSS17.0统计软件。我们将所有纳入的患者分为胰腺炎组和非胰腺炎组,将搜集的患者信息分为基线资料和ERCP相关资料两类。运用X2和t检验进行单因素分析,将得出的有意义的因素带入二元非线性回归进行多因素分析,从而得出影响ERCP术后胰腺炎发生的独立因素。其中,ERCP术后并发症的定义参照《内镜逆行胰胆管造影》第六章(ERCP并发症的预测、预防和治疗》中关于ERCP主要并发症的共识定义。胆总管扩张程度分级根据我中心ERCP操作经验进行,具体如下：胆总管直径d<1.0cm为正常,1cm2cm为重度扩张。
结果：1、在搜集整理的398例病例中,共327例病例符合标准并纳入统计学分析,其中术后并发胰腺炎23例(7.03%),均为轻症,经内科保守治疗后好转,无死亡病例。其余304例病例术后未并发胰腺炎。2、将所有纳入统计学分析的327例病例分为两组：胰腺炎组和非胰腺炎组。单因素分析结果显示ERCP术后胰腺炎的发生与患者既往是否患有胆囊结石、入院时直接胆红素、总胆红素、谷氨酸氨基转肽酶、丙氨酸氨基转肽酶、谷氨酰转肽酶、甘油三酯水平、以及ERCP术中观察到的胆总管扩张程度有关。3、多因素分析结果显示既往胆囊结石病史和胆总管扩张程度为影响PEP发生的独立因素。4、在并发胰腺炎的23例患者中,6例患者ERCP术中发现胆总管无扩张,17例患者ERCP术中观察到胆总管轻度扩张(1cm 结论：1、既往有胆囊结石病史、胆总管宽度越趋近于正常的胆总管结石患者,行ERCP乳头切开取石术后并发胰腺炎的可能性越大。2、既往文献中提到的性别、年龄、插管困难等因素在本研究中无明显统计学差异。
Background:More than50years have passed since ERCP have been wildly used in clinical practice. More and more study about the complication has been done and now people give more attention to the precaution. According to the previous study, patients-related factors and the procedure-related factors both influence the incidence of PEP. Objective:The goal of this study is to evaluate the influence factors of post-ERCP pancreatitis over398patients in our center.
Methods:We collected398cases in which patients received ERCP because of oledocholithiasis from2003to2011and327cases was chosen according to the inclusion and exclusion criteria. To do the data analysis, software SPSS17.0Stat. was used. The327cases was divided into two groups:PEP group and non-PEP group and the information that we collected was divided into two parts:the basic data and the ERCP-related data. We chose the X2test and t test to do the univariate analysis and the logistic regression to do the multiplicity. The definition of the complication of ERCP was made according to the Consensus of the de Complications of ERCP that was mentioned in 《ERCP》，Chapter6.The expansion degree of bile duct was made according to clinical experiences of our center which is normal(d≤1.0cm), mild(1cm Rrsults:1、The statistical analysis was performed on327patients, on whom the PEP was occurred, of the398patients.23(7.03%) patients who had the complications all suffered mild pancreatitis, and are all cured by conservative treatments and there was no death.2. All the cases was divided into two groups, the PEP group and the non-PEP group. The result of univariate analysis shows that the occurance of PEP was related with the medical history of cholecystolithiasis、TBIL、DBIL、ALT、AST、GGT、TG and the standard of oledochectasia.3、Multiplicity shows that only the medical history of cholecystolithiasis and the standard of oledochectasia are related.4.6of the patients who had PEP have normal bile duct and the other17patients have mild-expansive bile duct. None of the patients who have moderate or severe expansive bile duct suffer PEP.
Conclusion:1、The patient who has the medical history of cholecystolithiasis and a more normal choledoch has the lower risk of PEP.2、 Other risk factors such as sex、age、and operating related factors shows no statistical difference in our study.
目的：本研究的目的是探讨我中心2003-2011年间因胆总管结石行ERCP乳头切开取石术患者发生ERCP术后胰腺炎(PEP)的影响因素。
方法：搜集我中心2003-2011年398例胆总管结石行ERCP乳头切开取石术患者,对于他们的一般资料和ERCP相关资料进行系统的整理,根据纳入和排除标准,我们仅选取首次行ERCP乳头切开取石术的符合上述纳入标准的胆总管结石患者进入研究,对符合标准并纳入研究的327例病例的资料进行数据分析。数据分析运用SPSS17.0统计软件。我们将所有纳入的患者分为胰腺炎组和非胰腺炎组,将搜集的患者信息分为基线资料和ERCP相关资料两类。运用X2和t检验进行单因素分析,将得出的有意义的因素带入二元非线性回归进行多因素分析,从而得出影响ERCP术后胰腺炎发生的独立因素。其中,ERCP术后并发症的定义参照《内镜逆行胰胆管造影》第六章(ERCP并发症的预测、预防和治疗》中关于ERCP主要并发症的共识定义。胆总管扩张程度分级根据我中心ERCP操作经验进行,具体如下：胆总管直径d<1.0cm为正常,1cm
结果：1、在搜集整理的398例病例中,共327例病例符合标准并纳入统计学分析,其中术后并发胰腺炎23例(7.03%),均为轻症,经内科保守治疗后好转,无死亡病例。其余304例病例术后未并发胰腺炎。2、将所有纳入统计学分析的327例病例分为两组：胰腺炎组和非胰腺炎组。单因素分析结果显示ERCP术后胰腺炎的发生与患者既往是否患有胆囊结石、入院时直接胆红素、总胆红素、谷氨酸氨基转肽酶、丙氨酸氨基转肽酶、谷氨酰转肽酶、甘油三酯水平、以及ERCP术中观察到的胆总管扩张程度有关。3、多因素分析结果显示既往胆囊结石病史和胆总管扩张程度为影响PEP发生的独立因素。4、在并发胰腺炎的23例患者中,6例患者ERCP术中发现胆总管无扩张,17例患者ERCP术中观察到胆总管轻度扩张(1cm
Background:More than50years have passed since ERCP have been wildly used in clinical practice. More and more study about the complication has been done and now people give more attention to the precaution. According to the previous study, patients-related factors and the procedure-related factors both influence the incidence of PEP. Objective:The goal of this study is to evaluate the influence factors of post-ERCP pancreatitis over398patients in our center.
Methods:We collected398cases in which patients received ERCP because of oledocholithiasis from2003to2011and327cases was chosen according to the inclusion and exclusion criteria. To do the data analysis, software SPSS17.0Stat. was used. The327cases was divided into two groups:PEP group and non-PEP group and the information that we collected was divided into two parts:the basic data and the ERCP-related data. We chose the X2test and t test to do the univariate analysis and the logistic regression to do the multiplicity. The definition of the complication of ERCP was made according to the Consensus of the de Complications of ERCP that was mentioned in 《ERCP》，Chapter6.The expansion degree of bile duct was made according to clinical experiences of our center which is normal(d≤1.0cm), mild(1cm
Conclusion:1、The patient who has the medical history of cholecystolithiasis and a more normal choledoch has the lower risk of PEP.2、 Other risk factors such as sex、age、and operating related factors shows no statistical difference in our study.
引文
[1]P. B. Cotton, G. Eehman, J. Venues, et al. Endoscopic Sphincterotomy complications and their management:an attempt at consensus.[J].Gastrointestinal Endoscopy,1991,(37): 383-393
[2]Martin L. Freeman, Douglas B. Nelson, Stuart Sherman, et al.Complications of endoscopic biliary sphincterotomy. [J]. The New England Journal of Medicine,1996, (335): 909-918
[3]孟东凡,吴永东,冀明,等.国产加贝酯预防ERCP术后胰腺炎的临床研究.[J].中华消化内镜杂志,2007,(4)：100-102
[4]Carl D Frank, Douglas G Adler. Post-ERCP pancreatitis and its prevention. [J]. Nature Clincial Practice Gastroenterology& Hepatology.2006,(3):680-688
[5]Cheng CL, Sherman S, Watkins JL, et al. Risk factors for post-ERCP pancreatitis:a prospective multicenter study.[J]. Am J Gastroen terol,2006,101 (1):139-147
[6]E Christoforidis, I Goulimaris, I Kanellos, el al. Post-ERCP Pancreatitis and Hyperamylasemia:Patient-Related and Operative Risk Factors.[J].Endoscopy,2002, (34):286-292
[7]周丽雅,李柯.急性胰腺炎的诊治要点高淀粉酶血症.[J].医师进修杂志,2004,(9),：1-3
[8]李兆申,张文俊,潘雪,等.奥曲肽预防ERCP术后胰腺炎及高淀粉酶血症的多中心随机对照临床研究.[J].中华消化内镜杂志,2004,(1)：301-305
[9]张筱凤,张啸ERCP术后高淀粉酶血症和胰腺炎的相关危险因素.[J].中华消化内镜杂志,2004,(8)：287-288
[10]E Masci, G Toti, A Mariani, et al. Complications of Diagnostic and Therapeutic ERCP:A Prospective Multicenter Study.[J].The American Journal of Gastroenterology,2001, (96):417-423
[11]杨剑,张啸,张筱凤等.经内镜逆行胰胆管造影术联合十二指肠乳头括约肌切开术治疗胆总管结石.[J].中华全科医师杂志,2010,(9)：564-566
[12]贾国法,邹小平,吴丽颖,等,ERCP术后胰腺炎危险因素分析.[J].临床消化病杂志,2005,17,(1)：34-36
[13]张啸,张筱凤,吕文,等.416次针形刀困难乳头括约肌切开的体会.[J].中国微创外科杂志,2007,(7)：854-857
[14]Vikram Bhatia MD, Pramod Kumar (iarg MI), Rakcsh Kumarr Tandon MD,PhD,et al. Endoscopic Retrograde Cholangiopancreatography-induced Acute Pancreatitis of ten has a Benign Outcome.[J].J Clin Gastroenterol.2006,(40)726-731
[15]Yu Bai MD, Jun Gao MD, Duo-Wu Zou MD,et al.Prophylactic Octreotide Administration Does Not Prevent Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis A Meta-Analysis of Randomized Controlled Trials. [J].Pancreas.Volume 2008,(10):241-246
[16]Martin L. Freeman, MD, James A. DiSario, MD, Douglas B.et al. Risk factors for post-ERCP pancreatitis:a prospective, multicenter study.[J]. Gastrointestinal Endoscopy, 2001, (54):425-434.
[17]闫波,赵建妹,沈云志,等,EERCP术后胰腺炎的影响因素分析.[J].胰腺病学,2007,(7)：178-180
[18]车平,王洪林,凌康.内镜逆行胰胆管造影术后急性胰腺炎危险因素及预防进展.[J].检验医学与临床,2009,(6)453,474
[19]徐晓倩,张文俊,李兆申ERCP术后胰腺炎.[J].胰腺病学,3003,(3)：243-246
[20]李兆申,许田明,钱熙岱,等.胰腺疾病患者ERCP术后并发高淀粉酶血症及急性胰腺炎临床对比研究.[J]中华消化内镜杂志,1999,(16)：75
[21]Yan K.Chen, John D Addulian, Susana Escalante-Glorsky, et al. Clinical Outcome of Post-ERCP Pancreatitis:Relationship to History of Previous Pancreatitis.[J]. The American Journal of Gastroenterology,1995,(90):2120-2123
[22]李国熊,张啸ERCP并发症及防治对策.[J].中国内镜杂志,2005,(8),824-827
[23]Stuart Sherman, Thomas A. Ruffofo, Robert H. Hawes, et al. Complications of Endoscopic Sphincterotomy A Prospective Series With Emphasis on the Increased Risk Associated With Sphincter of Oddi Dysfunction and Nondilated Bile Ducts. [J]. Gasteroenterology,1991,(101):1068-1075
[24]刘卫,何小东,蔡磊,等.行胰胆管造影并发胰腺炎危险因素的分析.[J].中华消化外科杂志,2009,(8)：298-299
[25]Alberto Mariani, MD, Antonella Giussani, MD, Milena Di Leo, et al. Guidewire biliary cannulation does not reduce post-ERCP pancreatitis compared with the contrast injection technique in low-risk and high-risk patients.[J]. Gastrointestinal Endoscopy,2012, (75):339-346
[26]E. J. Williams, S. Taylor, P. Fairclough. et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. [J]. Endoscopy,2007,(39):793-801
[27]张东海,李兆申.中国ERCP的常见并发症及防治研究进展.[J].中国内镜杂志,2002,(8)：32-35
[28]E Masci, G. Toti, A. Mariani, et al. Complications of Diagnostic and Therapeutic ERCP:A Prospective Multicenter Study.[J]. The American Journal Of Gastroenterology,2001,(96):417-423
[29]黄永德,宛新建,孙振兴ENBD预防治疗性ERCP术后高淀粉酶血症及胰腺炎.[J].临床军医杂志,2007,(35)：346-348
[30]吴明浩,卢放根,周会新.鼻胆管引流预防ERCP术后并发症分析[J].Journal of Chinese Physician,2008,(10):1074-1075
[31]Martin L. Freeman, MD, Carol Overby, RN, Dongfeng Qi, MS, PhD.Pancreatic stent insertion:consequences of failure and results of a modified technique to maximize success. [J].Gastrointestinal Endoscopy,2004,(59):8-14
[32]陈震,秦鸣放.内镜逆行胰胆管造影术后胰腺炎的预防.[J].中国中西医结合外科杂志,2008,(14)：302-304
[33]高俊,许国铭.内镜逆行胰胆管造影术后胰腺炎的预防.[J].中华消化杂志,2009,(29)：138-140
[34]Carl D Frank, Douglas G Adler.Post-ERCP pancreatitis and its prevention.[J].Nature Clinical Practice Gastroenterology & Hepatology,2006,(3):680-688
[35]Douglas G. Adler, MD, FACG, FASGE, et al. Dye-free Wire-guided Cannulation of the Biliary Tree During ERCP is Associated With High Success and Low Complication Rates Outcomes in a Single Operator Experience of 822 Cases.[J]. J Clin Gastroenterol,2010, (44):57-62
[36]Everson L.A. Artifon, M.D., Ph.D., Paulo Sakai, M.D., Ph.D., Jose E.M. Cunha, M.D., Ph.D,et al. Guidewire Cannulation Reduces Risk of Post-ERCP Pancreatitis and Facilitates Bile Duct Cannulation. [J]. American Journal of Gastroenteroloey,2007, (102):2147-2153
[37]张志坚,李达周,刘建强,等.选择性插管减少逆行胰胆管造影术后胰腺炎的随机对照研究.[J].中华消化内科杂志,2007,(24)：250-253
[38]陈友平,何正在,郭良忠,等.经胰管乳头预切开后胰腺炎风险的回顾性分析.[J].临床消化病杂志,2011,(23)：53-54
[39]陈永忠.生长抑素预防治疗性ERCP术后高点粉酶血症及胰腺炎的临床观察.[J].中国现代药物应用,2010,(4),162-163
[40]宋军,刘俊,刘诗,等ERCP术后生长抑素对腆腺炎预防作用的随机对照研究.[J].中国医师杂志,2011：25-26
[41]刁凌云.沈云志.内镜逆行胰胆管造影术后胰腺炎的预防研究进展.[J].国际消化病杂志,2006,(26)：226-228
[42]Kyu lack Lee.MD PhD. Don Ilacng Lee, PhD, Byung Moo Yoo. MD PhD. The Prophylactic Effect of Somatostatin on Post-herapeutic Endoscopic Retrograde Cholangiopancreatography Pancreatitis A Randomized, Multicenter Controlled Trial.[J]. Pancreas,2008,(37):445-448
[43]Andriulli A,Clemente R,Solmi L,et al.Gahexate or somatostatin administration before ERCP in patients at high risk for post-FRCP pancreatitis:multicenter, placebo-controlled, randomized clinical trial.[J]. Gastrointest Endoscopy, 2002,(56):488-495
[44]张东海,李兆申ERCP相关并发症的危险因素及药物预防进展.[J].中华消化内镜杂志,2002,(19)：378-380
[45]吴叔明,徐华戈,之铮,等.加贝醋对Oddi括约肌运动的影响.[J].中华消化杂志,2004,(24)：464-467
[46]Stuart Sherman, MD, Chi-Liang Cheng, MD, Guido Costamagna, MD,et al. Efficacy of Recombinant Human Interleukin-10 in Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Subjects With Increased Risk.[J].Pancreas.2009, (38):267-274
[47]Manouchehr Khoshbaten, Homayoun Khorram, Leili Madad,et al.Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis.[J].Journal of Gastroenterology and Hepatology,2008,(23):11-16
[48]Bill Murrary, Ross Carter, Clem Imrie, et el. Diclofenac Reduces the Incidence of Acute Pancreatitis After Endoscopic Retrograde Cholangiopancreatography. [J]. Gastroenterology,2003, (124):1786-1791
[49]Rasoul Sotoudehmanesh, M.D., Morteza Khatibian, M.D., Shadi Kolahdoozan, M.D., et al. Indomethacin May Reduce the Incidence and Severity of Acute Pancreatitis After ERCP.[J].American Journal of Gastroenterology,2007,978-983
[50]Minghua Zheng, MD, Yongping Chen, MD, Jianling Bai, PhD,etal.Meta-Analysis of Prophylactic Allopurinol Use in Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.[J].Pancreas,2008,(37):247-253
[51]Rai Y, Gao J, Shi X, et al. Prophylactic corticosteroids do not prevent post-ERCP pancreatitis:a meta-analysis of randomized controlled trials. [J].Pancreatology,2008, (8):504-509
[52陈小薇,吴建胜,洪万东.硝酸甘油预防ERCP术后胰腺炎的荟萃分析.[J].中华胰腺病学杂志,2010,(10)：206-208
[53]Raty S, Sand J, Pulkkinen M,et al. Post-ERCP pancreatitis:reduction by routine antibiotics.[J].J Gastrointest Surg,2001,(5):339-345
[54]卫金歧,吕卫华,边壮,等.奥美拉唑预防逆行胰胆管造影术后急性胰腺炎的临床研究.[J].中国综合临床,2008,(24)：1049-1051
[55]刘存根,冷大跃,刘欢,等.清胰汤预防内镜逆行性胰胆管造影术后所致胰腺炎和高点粉酶血症的临床研究.[J]中国中西医结合杂志,2009,(29)：607-610
[56]杨绍旺,黄传英,单连云,等.柴芍承气汤对ERCP术后高淀粉酶血症的预防作用.[J].现代中西医结合杂志,2008,(17)：1998
[57]黄天生,朱生樑,何立入,等.中医对于急性胰腺炎发病机制的认识.[J].时珍国医国药,2007,(18)：2041
[58]王捷虹,张家墉,安君玲.大黄通胰汤灌肠治疗早期急性胰腺炎.[J].辽宁中医杂志,2007,(34)：923
[59]袁甲平.辨证治疗急性胰腺炎30例临床体会.[J].湖南中医杂志,1996,(3)：14-15
[60]赛丹.急性胰腺炎中医证型的文献分析.[J].湖北中医杂志,2010,(32)：34-36
[61]朱生樑,黄天生,王高峰.重症急性胰腺炎中医辨证治疗现状与展望.[J].时珍国医国药,2008,(19)：2811-2812
[62]焦东海,刘春堂,陆燮荣.单味生大黄治疗急性胰腺炎20例初步小结.[J].新医药学杂志,1978,(11)：33
[63]焦东海,沈学敏,景炳文.单位大黄治疗急性胰腺炎17年研究.[J].中医杂志,1994,(35)：172-173
[64]陈晓理,冉瑞图.大黄治疗坏死性胰腺炎的机理探讨.[J].华西医大学报,1996,27(4)：48-421
[65]薄世宁,张淑文,王宝恩.中药大黄对急性出血坏死性胰腺炎治疗作用的研究.[J].中国中西医结合急救杂志,2000,7(6)：362-364
[66]林三仁.消化内科学高级教程.[M].北京：人民军医出版社,2009：100
[67]Todd H Baron,Richard Kozarek,David L. Carr Locke内镜逆行胰胆管造影.[M].郭学刚,吴开春.北京：人民军医出版社,2009：47
[68]Raffaele Pezzilli, Elisabetta Romboli, Davide Campana,et al. Mechanisms Involved in the Onset of Post-ERCP Pancreatitis.[J]. JOP. J Pancreas.2002,3(6):162-168
[69]应卫星,朱畴文.内镜逆行胰胆管造影(ERCP)术后胰腺炎发病的机制研究进展及预防策略.[J].中国临床医学,2006,(132)：43-425
[70]邹声泉.胆道病学.[M].北京：人民卫生出版社,2010：433
[2]Martin L. Freeman, Douglas B. Nelson, Stuart Sherman, et al.Complications of endoscopic biliary sphincterotomy. [J]. The New England Journal of Medicine,1996, (335): 909-918
[3]孟东凡,吴永东,冀明,等.国产加贝酯预防ERCP术后胰腺炎的临床研究.[J].中华消化内镜杂志,2007,(4)：100-102
[4]Carl D Frank, Douglas G Adler. Post-ERCP pancreatitis and its prevention. [J]. Nature Clincial Practice Gastroenterology& Hepatology.2006,(3):680-688
[5]Cheng CL, Sherman S, Watkins JL, et al. Risk factors for post-ERCP pancreatitis:a prospective multicenter study.[J]. Am J Gastroen terol,2006,101 (1):139-147
[6]E Christoforidis, I Goulimaris, I Kanellos, el al. Post-ERCP Pancreatitis and Hyperamylasemia:Patient-Related and Operative Risk Factors.[J].Endoscopy,2002, (34):286-292
[7]周丽雅,李柯.急性胰腺炎的诊治要点高淀粉酶血症.[J].医师进修杂志,2004,(9),：1-3
[8]李兆申,张文俊,潘雪,等.奥曲肽预防ERCP术后胰腺炎及高淀粉酶血症的多中心随机对照临床研究.[J].中华消化内镜杂志,2004,(1)：301-305
[9]张筱凤,张啸ERCP术后高淀粉酶血症和胰腺炎的相关危险因素.[J].中华消化内镜杂志,2004,(8)：287-288
[10]E Masci, G Toti, A Mariani, et al. Complications of Diagnostic and Therapeutic ERCP:A Prospective Multicenter Study.[J].The American Journal of Gastroenterology,2001, (96):417-423
[11]杨剑,张啸,张筱凤等.经内镜逆行胰胆管造影术联合十二指肠乳头括约肌切开术治疗胆总管结石.[J].中华全科医师杂志,2010,(9)：564-566
[12]贾国法,邹小平,吴丽颖,等,ERCP术后胰腺炎危险因素分析.[J].临床消化病杂志,2005,17,(1)：34-36
[13]张啸,张筱凤,吕文,等.416次针形刀困难乳头括约肌切开的体会.[J].中国微创外科杂志,2007,(7)：854-857
[14]Vikram Bhatia MD, Pramod Kumar (iarg MI), Rakcsh Kumarr Tandon MD,PhD,et al. Endoscopic Retrograde Cholangiopancreatography-induced Acute Pancreatitis of ten has a Benign Outcome.[J].J Clin Gastroenterol.2006,(40)726-731
[15]Yu Bai MD, Jun Gao MD, Duo-Wu Zou MD,et al.Prophylactic Octreotide Administration Does Not Prevent Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis A Meta-Analysis of Randomized Controlled Trials. [J].Pancreas.Volume 2008,(10):241-246
[16]Martin L. Freeman, MD, James A. DiSario, MD, Douglas B.et al. Risk factors for post-ERCP pancreatitis:a prospective, multicenter study.[J]. Gastrointestinal Endoscopy, 2001, (54):425-434.
[17]闫波,赵建妹,沈云志,等,EERCP术后胰腺炎的影响因素分析.[J].胰腺病学,2007,(7)：178-180
[18]车平,王洪林,凌康.内镜逆行胰胆管造影术后急性胰腺炎危险因素及预防进展.[J].检验医学与临床,2009,(6)453,474
[19]徐晓倩,张文俊,李兆申ERCP术后胰腺炎.[J].胰腺病学,3003,(3)：243-246
[20]李兆申,许田明,钱熙岱,等.胰腺疾病患者ERCP术后并发高淀粉酶血症及急性胰腺炎临床对比研究.[J]中华消化内镜杂志,1999,(16)：75
[21]Yan K.Chen, John D Addulian, Susana Escalante-Glorsky, et al. Clinical Outcome of Post-ERCP Pancreatitis:Relationship to History of Previous Pancreatitis.[J]. The American Journal of Gastroenterology,1995,(90):2120-2123
[22]李国熊,张啸ERCP并发症及防治对策.[J].中国内镜杂志,2005,(8),824-827
[23]Stuart Sherman, Thomas A. Ruffofo, Robert H. Hawes, et al. Complications of Endoscopic Sphincterotomy A Prospective Series With Emphasis on the Increased Risk Associated With Sphincter of Oddi Dysfunction and Nondilated Bile Ducts. [J]. Gasteroenterology,1991,(101):1068-1075
[24]刘卫,何小东,蔡磊,等.行胰胆管造影并发胰腺炎危险因素的分析.[J].中华消化外科杂志,2009,(8)：298-299
[25]Alberto Mariani, MD, Antonella Giussani, MD, Milena Di Leo, et al. Guidewire biliary cannulation does not reduce post-ERCP pancreatitis compared with the contrast injection technique in low-risk and high-risk patients.[J]. Gastrointestinal Endoscopy,2012, (75):339-346
[26]E. J. Williams, S. Taylor, P. Fairclough. et al. Risk factors for complication following ERCP; results of a large-scale, prospective multicenter study. [J]. Endoscopy,2007,(39):793-801
[27]张东海,李兆申.中国ERCP的常见并发症及防治研究进展.[J].中国内镜杂志,2002,(8)：32-35
[28]E Masci, G. Toti, A. Mariani, et al. Complications of Diagnostic and Therapeutic ERCP:A Prospective Multicenter Study.[J]. The American Journal Of Gastroenterology,2001,(96):417-423
[29]黄永德,宛新建,孙振兴ENBD预防治疗性ERCP术后高淀粉酶血症及胰腺炎.[J].临床军医杂志,2007,(35)：346-348
[30]吴明浩,卢放根,周会新.鼻胆管引流预防ERCP术后并发症分析[J].Journal of Chinese Physician,2008,(10):1074-1075
[31]Martin L. Freeman, MD, Carol Overby, RN, Dongfeng Qi, MS, PhD.Pancreatic stent insertion:consequences of failure and results of a modified technique to maximize success. [J].Gastrointestinal Endoscopy,2004,(59):8-14
[32]陈震,秦鸣放.内镜逆行胰胆管造影术后胰腺炎的预防.[J].中国中西医结合外科杂志,2008,(14)：302-304
[33]高俊,许国铭.内镜逆行胰胆管造影术后胰腺炎的预防.[J].中华消化杂志,2009,(29)：138-140
[34]Carl D Frank, Douglas G Adler.Post-ERCP pancreatitis and its prevention.[J].Nature Clinical Practice Gastroenterology & Hepatology,2006,(3):680-688
[35]Douglas G. Adler, MD, FACG, FASGE, et al. Dye-free Wire-guided Cannulation of the Biliary Tree During ERCP is Associated With High Success and Low Complication Rates Outcomes in a Single Operator Experience of 822 Cases.[J]. J Clin Gastroenterol,2010, (44):57-62
[36]Everson L.A. Artifon, M.D., Ph.D., Paulo Sakai, M.D., Ph.D., Jose E.M. Cunha, M.D., Ph.D,et al. Guidewire Cannulation Reduces Risk of Post-ERCP Pancreatitis and Facilitates Bile Duct Cannulation. [J]. American Journal of Gastroenteroloey,2007, (102):2147-2153
[37]张志坚,李达周,刘建强,等.选择性插管减少逆行胰胆管造影术后胰腺炎的随机对照研究.[J].中华消化内科杂志,2007,(24)：250-253
[38]陈友平,何正在,郭良忠,等.经胰管乳头预切开后胰腺炎风险的回顾性分析.[J].临床消化病杂志,2011,(23)：53-54
[39]陈永忠.生长抑素预防治疗性ERCP术后高点粉酶血症及胰腺炎的临床观察.[J].中国现代药物应用,2010,(4),162-163
[40]宋军,刘俊,刘诗,等ERCP术后生长抑素对腆腺炎预防作用的随机对照研究.[J].中国医师杂志,2011：25-26
[41]刁凌云.沈云志.内镜逆行胰胆管造影术后胰腺炎的预防研究进展.[J].国际消化病杂志,2006,(26)：226-228
[42]Kyu lack Lee.MD PhD. Don Ilacng Lee, PhD, Byung Moo Yoo. MD PhD. The Prophylactic Effect of Somatostatin on Post-herapeutic Endoscopic Retrograde Cholangiopancreatography Pancreatitis A Randomized, Multicenter Controlled Trial.[J]. Pancreas,2008,(37):445-448
[43]Andriulli A,Clemente R,Solmi L,et al.Gahexate or somatostatin administration before ERCP in patients at high risk for post-FRCP pancreatitis:multicenter, placebo-controlled, randomized clinical trial.[J]. Gastrointest Endoscopy, 2002,(56):488-495
[44]张东海,李兆申ERCP相关并发症的危险因素及药物预防进展.[J].中华消化内镜杂志,2002,(19)：378-380
[45]吴叔明,徐华戈,之铮,等.加贝醋对Oddi括约肌运动的影响.[J].中华消化杂志,2004,(24)：464-467
[46]Stuart Sherman, MD, Chi-Liang Cheng, MD, Guido Costamagna, MD,et al. Efficacy of Recombinant Human Interleukin-10 in Prevention of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis in Subjects With Increased Risk.[J].Pancreas.2009, (38):267-274
[47]Manouchehr Khoshbaten, Homayoun Khorram, Leili Madad,et al.Role of diclofenac in reducing post-endoscopic retrograde cholangiopancreatography pancreatitis.[J].Journal of Gastroenterology and Hepatology,2008,(23):11-16
[48]Bill Murrary, Ross Carter, Clem Imrie, et el. Diclofenac Reduces the Incidence of Acute Pancreatitis After Endoscopic Retrograde Cholangiopancreatography. [J]. Gastroenterology,2003, (124):1786-1791
[49]Rasoul Sotoudehmanesh, M.D., Morteza Khatibian, M.D., Shadi Kolahdoozan, M.D., et al. Indomethacin May Reduce the Incidence and Severity of Acute Pancreatitis After ERCP.[J].American Journal of Gastroenterology,2007,978-983
[50]Minghua Zheng, MD, Yongping Chen, MD, Jianling Bai, PhD,etal.Meta-Analysis of Prophylactic Allopurinol Use in Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis.[J].Pancreas,2008,(37):247-253
[51]Rai Y, Gao J, Shi X, et al. Prophylactic corticosteroids do not prevent post-ERCP pancreatitis:a meta-analysis of randomized controlled trials. [J].Pancreatology,2008, (8):504-509
[52陈小薇,吴建胜,洪万东.硝酸甘油预防ERCP术后胰腺炎的荟萃分析.[J].中华胰腺病学杂志,2010,(10)：206-208
[53]Raty S, Sand J, Pulkkinen M,et al. Post-ERCP pancreatitis:reduction by routine antibiotics.[J].J Gastrointest Surg,2001,(5):339-345
[54]卫金歧,吕卫华,边壮,等.奥美拉唑预防逆行胰胆管造影术后急性胰腺炎的临床研究.[J].中国综合临床,2008,(24)：1049-1051
[55]刘存根,冷大跃,刘欢,等.清胰汤预防内镜逆行性胰胆管造影术后所致胰腺炎和高点粉酶血症的临床研究.[J]中国中西医结合杂志,2009,(29)：607-610
[56]杨绍旺,黄传英,单连云,等.柴芍承气汤对ERCP术后高淀粉酶血症的预防作用.[J].现代中西医结合杂志,2008,(17)：1998
[57]黄天生,朱生樑,何立入,等.中医对于急性胰腺炎发病机制的认识.[J].时珍国医国药,2007,(18)：2041
[58]王捷虹,张家墉,安君玲.大黄通胰汤灌肠治疗早期急性胰腺炎.[J].辽宁中医杂志,2007,(34)：923
[59]袁甲平.辨证治疗急性胰腺炎30例临床体会.[J].湖南中医杂志,1996,(3)：14-15
[60]赛丹.急性胰腺炎中医证型的文献分析.[J].湖北中医杂志,2010,(32)：34-36
[61]朱生樑,黄天生,王高峰.重症急性胰腺炎中医辨证治疗现状与展望.[J].时珍国医国药,2008,(19)：2811-2812
[62]焦东海,刘春堂,陆燮荣.单味生大黄治疗急性胰腺炎20例初步小结.[J].新医药学杂志,1978,(11)：33
[63]焦东海,沈学敏,景炳文.单位大黄治疗急性胰腺炎17年研究.[J].中医杂志,1994,(35)：172-173
[64]陈晓理,冉瑞图.大黄治疗坏死性胰腺炎的机理探讨.[J].华西医大学报,1996,27(4)：48-421
[65]薄世宁,张淑文,王宝恩.中药大黄对急性出血坏死性胰腺炎治疗作用的研究.[J].中国中西医结合急救杂志,2000,7(6)：362-364
[66]林三仁.消化内科学高级教程.[M].北京：人民军医出版社,2009：100
[67]Todd H Baron,Richard Kozarek,David L. Carr Locke内镜逆行胰胆管造影.[M].郭学刚,吴开春.北京：人民军医出版社,2009：47
[68]Raffaele Pezzilli, Elisabetta Romboli, Davide Campana,et al. Mechanisms Involved in the Onset of Post-ERCP Pancreatitis.[J]. JOP. J Pancreas.2002,3(6):162-168
[69]应卫星,朱畴文.内镜逆行胰胆管造影(ERCP)术后胰腺炎发病的机制研究进展及预防策略.[J].中国临床医学,2006,(132)：43-425
[70]邹声泉.胆道病学.[M].北京：人民卫生出版社,2010：433