内镜下十二指肠乳头括约肌切开术后发生胆管炎的危险因素分析  

High-risk factors for cholangitis after endoscopic sphincterotomy

作　　者：张钰[1] ZHANG Yu.(Department of Gastroenterology, The Central Hospital of Zhoukou, Zhoukou, Henan 466000, Chin)

机构地区：[1]周口市中心医院消化科,河南周口466000

出　　处：《临床肝胆病杂志》2017年第7期1316-1319,共4页Journal of Clinical Hepatology

摘　　要：目的探讨内镜下十二指肠乳头括约肌切开术(EST)术后发生胆管炎的高危因素,为临床防治提供参考。方法选取周口市中心医院2013年6月-2016年1月收治的196例行EST的患者作为研究对象,将其中31例术后发生胆管炎的患者作为感染组,其余165例作为对照组,对两组患者术后发生胆管炎的相关因素进行分析。计量资料2组间比较采用t检验;计数资料2组间比较采用χ~2检验,将有统计学意义的变量再进行多因素的非条件logistic回归分析。结果单因素分析结果显示感染组和对照组在既往胆道手术史[8(25.81%)vs 10(6.06%),χ~2=12.200,P=0.000 5]、胆总管结石的数量(2.8±0.5 vs 2.2±0.6,t=5.234,P=0.000 5)、合并胆囊结石伴胆囊炎[8(25.81%)vs 13(7.88%),χ~2=6.994,P=0.000 4]、合并肝内胆管结石[6(19.35%)vs 8(4.85%),χ~2=8.280,P=0.004 0]、手术时间[(35.6±5.8)min vs(27.1±6.2)min,t=7.072,P=0.000 4]、是否碎石[10(32.26%)vs 15(9.09%),χ~2=10.591,P=0.000 1]、术后胆道积气[12(60.00%)vs 16(21.82%),χ~2=17.940,P=0.000 2]和应用抗生素持续时间[(3.6±0.7)d vs(4.5±0.8)d,t=5.854,P=0.000 6]等方面比较差异均有统计学意义;多因素非条件的Logistic回归分析显示既往胆道手术史[比值比(OR)及95%可信区间(95%CI):1.962(1.156~3.658),P=0.024]、胆总管结石的数量[OR(95%CI):2.632(1.366~5.013),P=0.021]、合并肝内胆管结石[OR(95%CI):2.976(1.482~5.536),P=0.024]、手术时间[OR(95%CI):4.859(2.513~8.622),P=0.006]、术后胆道积气[OR(95%CI):5.326(2.633~10.524),P=0.005]是EST术后发生胆管炎的独立危险因素,其中应用抗生素持续时间[OR(95%CI):0.565(0.263~0.895),P=0.009]是其保护因素。结论对影响EST术后发生胆管炎的相关危险因素积极进行干预,对预防EST术后发生胆管炎有重要的临床意义。Objective To investigate the high-risk factors for cholangitis after endoscopic sphincterotomy（EST）,and to provide a reference for clinical prevention and treatment.Methods A total of 196 patients who underwent EST in our hospital from June 2013 to January2016 were enrolled,among whom 31 experienced cholangitis after EST（infection group） and 165 had no cholangitis（control group）.Related factors were analyzed for both groups.The t-test was used for comparison of continuous data between groups;the chi-square test was used for comparison of categorical data between groups,and a multivariate non-conditional logistic regression analysis was performed for variables with statistical significance.Results The univariate analysis showed that there were significant differences between the two groups in the past history of biliary tract surgery [8（25.81%） vs 10（6.06%）,χ^2=12.200,P=0.000 5],number of common bile duct stones（2.8 ± 0.5 vs 2.2 ± 0.6,t=5.234,P=0.000 5）,gallstones complicated by cholecystitis [8（25.81%） vs 13（7.88%）,χ^2=6.994,P=0.000 4],intrahepatic bile duct stones [6（19.35%） vs 8（4.85%）,χ^2=8.280,P=0.004 0],time of operation（35.6 ± 5.8 min vs 27.1± 6.2 min,t=7.072,P=0.000 4）,presence or absence of lithotripsy [10（32.26%） vs 15（9.09%）,χ^2=10.591,P=0.000 1],postoperative pneumobilia [12（60.00%） vs 16（21.82%）,χ^2=17.940,P=0.000 2],and duration of the use of antibiotics（3.6 ± 0.7 d vs4.5 ± 0.8 d,t=5.854,P=0.000 6）.The multivariate non-conditional logistic regression analysis showed that past history of biliary tract surgery [OR（95% CI）=1.962（1.156-3.658）,P=0.024],number of common bile duct stones [OR（95% CI）=2.632（1.366-5.013）,P=0.021],intrahepatic bile duct stones [OR（95% CI）=2.976（1.482-5.536）,P=0.024],time of operation [OR（95%CI）=4.859（2.513-8.622）,P=0.006],postoperative pneumobilia [OR（95% CI）=5.326（2.633-10.524）,P=0.005 ],and duration of the use of antibiotics [OR（95% CI）=0.565（0.263-0.895）

关 键 词：括约肌切开术 内窥镜 胆管炎 危险因素 

分 类 号：R657.4[医药卫生—外科学]