中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (04): 473-476.DOI: 10.19538/j.cjps.issn1005-2208.2024.04.21

• 论著 • 上一篇    下一篇

日间病房开展内镜逆行胰胆管造影的可行性和安全性分析

陈    俊1，秦璐翠2，黄    帅1，王贵阳1，姚俊发1，王    辉1，李可为1，吴文广1，刘颖斌1   

  1. 1上海交通大学医学院附属仁济医院胆胰外科，上海 200127；2上海交通大学医学院附属新华医院内镜中心，上海 200092 
  • 出版日期:2024-04-01 发布日期:2024-05-07

  • Online:2024-04-01 Published:2024-05-07

摘要： 目的    探讨日间病房开展内镜逆行胰胆管造影（ERCP）的安全性和可行性。方法    回顾性分析2020年6月至2023年7月上海交通大学医学院附属仁济医院日间病房常规接受ERCP治疗的3555例病人的临床资料。分析病人的基本资料、手术情况、延迟出院和二次入院原因，比较住院时间＞48 h（延迟出院）与住院时间≤48 h病人的临床资料。结果    3538例（99.5%）病人ERCP手术成功，手术时间为20（5~124）min，总住院时间为（37.9±19.9）h，108例（3%）术后发生并发症。3136例（88.2%）病人在48 h内顺利出院，419例（11.8%）延迟出院。在延迟出院病人中，术前胆源性胰腺炎185例，术后胰腺炎70例，消化道出血3例，十二指肠穿孔2例，单纯腹痛或呕吐84例，发热75例。1周内二次入院20例（0.6%）。延迟出院病人并发症发生率和住院费用高于住院时间≤48 h病人（P＜0.05），在年龄、性别、疾病构成（除胆管结石外）和二次入院比例方面二者差异无统计学意义（P＞0.05）。结论    对于日间ERCP适应证，除中重度胆源性胰腺炎病人外，无需考虑病种、年龄、性别及合并症等因素，且团队分工协作是确保日间ERCP顺利开展的基础。

关键词: 内镜逆行胰胆管造影, 日间病房, 延迟出院

Abstract: Safety and efficacy analysis of ambulatory endoscopic retrograde cholangio-pancreatography        CHEN Jun*，QIN Lu-cui，HUANG Shuai，et al. *Department of Biliary-pancreatic Surgery，Renji Hospital，School of Medicine，Shanghai Jiaotong University，Shanghai 200127，China 
Corresponding authors：WU Wen-guang，E-mail：wuwenguang08@126.com；LIU Ying-bin，E-mail：laoniulyb@163.com
CHEN Jun and QIN Lu-cui are  the first authors who contributed equally to the article
Abstract    Objective    To evaluate the safety and efficacy of endoscopic retrograde cholangio-pancreatography (ERCP) in the ambulatory ward. Methods    We retrospectively collected clinical data of patients who underwent ERCP in the ambulatory ward of Renji Hospital，Shanghai Jiao Tong University，from June 2021 to July 2023. Baseline features，surgical outcomes，reasons for delayed discharge，and incidents of readmission were analyzed. The differences between the delayed discharge group (>48 h) and the group with a hospital stay of less than 48 hours were compared. Results    3538(99.5%) patients successfully completed the operation，with an average operation time of 20(5~124) minutes，and an average total hospital stay of 37.91 ± 19.91 hours. 108(3%) patients had postoperative complications. 3136(88.2%) patients were successfully discharged within 48 hours. Among 419(11.8%) delayed discharge patients，there were 185 preoperative biliary pancreatitis，70 postoperative pancreatitis，3 gastrointestinal bleeding，2 duodenal perforation，84 abdominal pain or vomiting，and 75 fever. Rehospitalization within one week occurred in 20 cases (0.6%). The incidence of complications，and hospitalization costs were higher in the delayed discharge group compared to those hospitalized for less than 48 hours (P<0.05)，while there was no significant difference in age，gender，disease type (except bile duct stones), and rehospitalization rate (P>0.05). Conclusion    The inclusion criteria of Ambulatory ERCP exclude cases of moderate or severe preoperative biliary pancreatitis, without considering disease type, age, gender, and comorbidities of patients. ERCP team’s cooperation ensures successful implementation of ambulatory ERCP.

Key words: endoscopic retrograde cholangiopancreatography, ambulatory ward, delayed discharge