十二指肠乳头结石嵌顿并发急性胆石性胰腺炎的危险因素:病例对照研究  

Risk factors of duodenal papillary impacted stones with acute gallstone pancreatitis:case-control designs

作　　者：王奥 李宁[2,3] 王震宇[2,3] 张莉[3] 赵卫川[3] WANG Ao;LI Ning;WANG Zhen-yu;ZHANG Li;ZHAO Wei-chuan(Graduate School of Tianjin Medical University,Tianjin 300070,China;Department of Hepatobiliary Surgery,Tanjin Nankai Hospital,Tianjin 300100,China;Department of Endoscopy Center,Tianjin Nankai Hospital,Tianjin 300100,China)

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市南开医院肝胆胰外三科,天津300100 [3]天津市南开医院内镜中心,天津300100

出　　处：《天津医科大学学报》2021年第6期632-636,共5页Journal of Tianjin Medical University

摘　　要：目的:探讨十二指肠乳头结石嵌顿并发急性胆石性胰腺炎(AGP)的危险因素。方法:回顾性分析天津市南开医院2009年1月—2018年12月收治的249例经内镜逆行胰胆管造影术(ERCP)诊治的十二指肠乳头结石嵌顿患者的临床资料,根据ERCP术前是否并发AGP分为胰腺炎组(146例)、非胰腺炎组(103例)。观察指标包括:(1)临床因素:黄疸、血清肝酶学、急性胆管炎、血脂(血清甘油三酯、总胆固醇)和诊治前住院时间。(2)病理因素:十二指肠乳头张力状态、乳头开口类型、结石嵌顿部位、嵌顿结石大小、胆总管直径和胆总管近端结石。比较上述指标的组间差异,并采用Logistic回归分析法行单因素、多因素分析。结果:与非胰腺炎组比较,胰腺炎组合并黄疸(χ^(2)=8.850,P=0.004)、急性胆管炎(χ^(2)=9.348,P=0.002)、高脂血症(χ^(2)=7.757,P=0.006)更多,且高张力乳头占比(χ^(2)=4.017,P=0.047)、点圆状乳头开口占比(χ^(2)=8.231,P=0.005)和乳头远端结石嵌顿占比(χ^(2)=5.796,P=0.019)更高。多因素二分类Logistic回归分析显示,黄疸(OR=2.171,95%CI:1.063~4.427)、急性胆管炎(OR=2.101,95%CI:1.214~3.638)、高脂血症(OR=2.267,95%CI:1.273~4.036)和点圆状乳头开口(OR=2.197,95%CI:1.126~4.289)是并发AGP的危险因素。结论:在十二指肠乳头结石嵌顿的患者中,黄疸、急性胆管炎、高脂血症和点圆状乳头开口是并发AGP的危险因素。Objective:To investigate the risk factors of acute gallstone pancreatitis(AGP)with duodenal papilla impacted stones.Methods:A total of 249 patients with stones impacted in the primitive duodenal papilla diagnosed and treated by endoscopic retrograde cholangiopancreatography(ERCP)in Tianjin Nankai Hospital from January 2009 to December 2018 were included in this research.The patients were divided into pancreatitis group(146 cases)and non-pancreatitis group(103 cases)according to the complication of AGP before ERCP.Observation indexes included(1)clinical factors:jaundice,serum hepatology,acute cholangitis,blood lipids(serum total cholesterol,serum triglyceride)and length of hospital stay before ERCP;(2)pathological factors:tension state of duodenal papilla,type of papilla opening,location of stone impaction,size of impacted stone,diameter of common bile duct and proximal common bile duct stone.The differents of the above indexes were compared.Univariate and multivariate analyses were performed on the observed indexes by Logistic regression analysis.Results:Compared with the non-pancreatitis group,pancreatitis group had more jaundice(χ^(2)=8.850,P=0.004),more acute cholangitis(χ^(2)=9.348,P=0.002),more hyperlipidemia(χ^(2)=7.757,P=0.006),more high-tension papilla(χ^(2)=4.017,P=0.047),more punctate round papillary openings(χ^(2)=8.231,P=0.002)and more proximal papillary stone incarceration(χ^(2)=5.796,P=0.019).Multivariate binary Logistic regression analysis showed that jaundice(OR=2.171,95%CI:1.063-4.427),acute cholangitis(OR=2.101,95%CI:1.214-3.638),hyperlipidemia(OR=2.267,95%CI:1.273-4.036)and punctate round papillary opening(OR=2.197,95%CI:1.126-4.289)were risk factors of concurrent AGP.Conclusion:Jaundice,acute cholangitis,hyperlipidemia and punctate round papilla opening are risk factors for AGP in patients with impacted duodenal papilla stones.

关 键 词：急性胆石性胰腺炎 结石嵌顿 危险因素 

分 类 号：R657.4[医药卫生—外科学] R657.5[医药卫生—临床医学]