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分析  

Acute gallstone pancreatitis caused by duodenal papillary impacted stone:a study on its risk factors based on ERCP findings

作　　者：王奥 任少华 王震宇 王庆[2] 勾承月 赵卫川 张莉[3] 李宁[2] Wang Ao;Ren Shaohua;Wang Zhenyu;Wang Qing;Gou Chengyue;Zhao Weichuan;Zhang Li;Li Ning(Graduate School of Tianjin Medical University,Tianjin 300070,China;Department of Hepatobiliary Surgery,the Integrated Chinese and Western Medicine Hospital of Tianjin University,Tianjin 300100,China;Department of Endoscopy Center,the Integrated Chinese and Western Medicine Hospital of Tianjin University,Tianjin 300100,China)

机构地区：[1]天津医科大学研究生院,300070 [2]天津大学中西医结合医院肝胆胰外科,300100 [3]天津大学中西医结合医院内镜中心,300100

出　　处：《中华肝胆外科杂志》2021年第12期905-908,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的基于经内镜逆行胰胆管造影(ERCP),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2009年1月至2020年12月天津大学中西医结合医院收治的行ERCP的十二指肠乳头结石嵌顿患者的临床资料,共304例,其中男性177例,女性127例,中位年龄65.0岁。根据入院时是否并发胰腺炎分为AGP组(n=174)和非AGP组(n=130)。收集患者围手术期资料。多因素logistic回归分析筛选十二指肠乳头结石嵌顿患者并发AGP的危险因素。结果多因素分析结果显示,并发急性胆管炎(OR=2.114,95%CI:1.279~3.494)和嵌顿结石最大径≤5 mm(OR=1.738,95%CI:1.064~2.840)是十二指肠乳头结石嵌顿并发AGP的独立危险因素(P<0.05)。两组均未出现与ERCP治疗相关的穿孔和死亡病例。AGP组和非AGP组症状缓解时间分别为术后(2.67±1.19)和(1.88±0.88)d,两组比较,差异具有统计学意义(t=-6.321,P<0.001)。结论在十二指肠乳头嵌顿结石患者中,并发急性胆管炎及嵌顿结石最大径≤5 mm者发生AGP风险更高,临床上应尽早干预。ObjectiveTo study the risk factors of acute gallstone pancreatitis(AGP)caused by impaction of duodenal papilla stones based on ERCP findings to provide evidence on prevention of AGP caused by stone impaction.MethodsThe data of 304 patients with duodenal papilla stone impaction who were treated by ERCP at the Integrated Chinese and Western Medicine Hospital of Tianjin University from January 2009 to December 2020 were analyzed retrospectively.There were 177 males and 127 females,with a median age of 65.0 years.These patients were divided into the AGP group(n=174)and the non-AGP group(n=130)according to whether they developed acute pancreatitis before hospitalization.The analysis was performed on perioperative data.Multivariate logistic regression analysis was used to detect risk factors of AGP in patients with duodenal papillary stone impaction.ResultsMultivariate logistic analysis showed that acute cholangitis(OR=2.114,95%CI:1.279-3.494,P<0.05)and impacted stones≤5 mm(OR=1.738,95%CI:1.064-2.840,P<0.05)were independent risk factors of duodenal papillary stone impaction complicated with AGP.No perforation and death related to ERCP treatment occurred in both groups.The symptom alleviating time of patients in the AGP versus the non-AGP groups was(2.67±1.19)versus(1.88±0.88)d respectively(t=-6.321,P<0.001).ConclusionAmong patients with duodenal papilla impacted stones,acute cholangitis and impacted stones≤5 mm were risk factors of developing AGP,and ERCP should be carried out as early as possible.

关 键 词：胰腺炎 胆结石 肝胰管壶腹 危险因素 

分 类 号：R576[医药卫生—消化系统] R574.51[医药卫生—内科学] R575.62[医药卫生—临床医学]