| Objective:1.Retrospective study on risk factors for ERCP-related complications; 2.Retrospective study on value of antibiotic prophylaxis for ERCP:can reduce the postoperative complications occurring and the hospitalization cost and postoperative hospitalization days or not.Methods:1.Study on the risk factors for therapeutic ERCP-related complications:From January 1, 2011 to December 31, 2013,All of the patients who underwent ERCP in endoscopy center of the first affiliated hospital of Nanchang university.After a strict internalizing and elimination standard,a total of 1951 patients in this study, 277 patients suffered complications,1674 without complications, retrospective study on cases of ERCP complications, multi-factor analysis,to study Risk factors for ERCP-related complications. It is statistical significance that P<0.05. 2.On value of Antibiotic prophylaxis for ERCP: In the 1951 patients, were divided into 2 groups: the first group is the experimental group that patients use antibiotic prophylaxis, the second group without antibiotic is control. Group one, a total of 630 people, group two have 1321 patients.There is no statistical difference between the two groups such as age, sex,based diseases,blood tests,disease diagnosis, transpancreatic sphincterotomy or not, ENBD or not, number and time of ERCP and so on. Observed those two groups patients the volume of 3h postoperative amylase,24 h postoperative amylase, routine blood test Take χ2 test using SAS statistic software Numeration data were analyzed in precise probability calculation,measurement data were analyzed in t test.It is statistical significance that P<0.05. 3.To study on the value of antibiotic prophylaxis for ERCP:can reduce the postoperative complications occurrence or not,and can reduce the cost of hospitalization and postoperative hospitalization days or not.Results:1.About risk factors for ERCP-related complications:In those 277 patients whosuffered complications:pancreatitis was observed in 101( 5.2% of the total) patients,hyperamylasemia,(not including pancreatitis) in54(2.8%) patients, hemorrhage in 8(0.4%) patients, cholangitis in 134(6.9%) patients and perforation in 1(0.05%) patients. The ORs for cholangiocarcinoma was 2.39,(95%CI 1.38-4.14), for long operation time(>60 minutes) 3.77(95%CI 1.23-11.53),and transpancreatic sphincterotomy was 2.56(95%CI 1.28-5.14).,and into pancreatic duct was 1.43(95%CI 1.08-1.87),so these four risks were found to be independent risk factors for PEP. For post-cholangitis: the ORs for cholangiocarcinoma was 2.93(95%CI 1.88-4.56), and for many times of ERCP during the period of hospitalization was 2.53,( 95%CI 1.627-3.93)were found to be independent risk factors for post-cholangitis, However, The ORs for cholangiocarcinoma was antibiotics prophylaxis was 0.65,( 95%CI0.39-0.611), transpancreatic sphincterotomya’s OR was 0.65,(95%CI 0.436-0.65) were considered as the protective factors for post-cholangitis. 2.The part about ERCP postoperative of antibiotic prophylaxis can reduce postoperative complications or not:(1) About the overall complications: 196 patients in control group had complications(196/1321,14.8%),and 81 patients of them had complications in the experimental group(81/630,12.9%),χ2=1.373,P =0.24,;(2)About the PEP:70 patients in control group had PEP(70/1321,5.3%),however, 31 patients of them had PEP in the experimental group(31/630,4.9%),χ2=0.124,P=0.72;(3)About the hyperamylasemia:35 patients in control group had complicated with hyperamylasemia( 35/1321,2.6%),while the experimental group has 19 hyperamylasemia(19/630,3%), χ2=0.213,P=0.72;(4)About the post-cholecystitis:106 patients in control group had cholecystitis(106/1321,8.02%),however, 28 patients in the experimental group(28/630,4%,),χ2=0.85, P=0.03, the result had statistical significance;(5) About the ERCP-associated bleeding:2 patients in control group had bleeding(2/1321,0.1%), and 6 patients in the experimental group(6/630,0.9%),χ2=0.213,P=0.72.(6)About the post intstinal obstruction: patients in control group had one complicated with intstinal obstruction(1/1321,0.07%),but no patient had perforation in another group( 0/630,0)(7)About the post-ERCP perforation: patients in control group had no one complicated with bleeding(0/1321,0%),but 1 patient had perforation in another group(1/630,0.1%)χ2=0.48, P=0.49. 3.About antibiotic prophylaxis for ERCP:can reduce the hospitalization cost and postoperative hospitalization days or not:The mean hospitalization days of antibiotic group of ERCP are(4.6±4.53)days,whereas,the group without antibiotic are(4.5±4.65)days,(t=-0.551, P=0.58).The mean of hospitalization cost of antibiotic group of ERCP are(14299.2±8032.4)yuan,whereas,the group without antibiotic are(13948±8032.1)yuan,(t=-0.82, P=0.41).Conclusion:1.Cholangiocarcinoma,transpancreatic sphincterotomy,long operation time(>60 minutes) and into the pancreatic duct during the operaion were considered as the independent risk factors for PEP. And cholangiocarcinoma and many times of ERCP during the period of hospitalization were found to be independent risk factors for post-cholangitis,However,antibiotics prophylaxis after ERCP, transpancreatic sphincterotomy were considered as the protective factors for post-cholangitis. 2.Antibiotic prophylaxis for post-ERCP can reduce the occurrence of post cholangitis who was diagnosised as cholangiocarcinoma,or had many times of ERCP during the period of hospitalization or had without EST. But it cannot reduce the incidence of PEP, hyperamylasemia,bleeding,intstinal obstruction and perforation. 3. Antibiotic prophylaxis for ERCP:can not reduce the hospitalization cost and postoperative hospitalization days. |
PDF Full Text Request