胆总管结石合并壶腹周围憩室临床特征及行ERCP发生困难插管的影响因素分析(附1920例报告)  

Clinical characteristics of choledocholithiasis combined with periampullary diverticulum and influencing factor analysis for difficult cannulation of endoscopic retrograde cholangiopan-creatography:a report of 1920 cases

作　　者：岳平[1] 王震宇[2] 张雷达 孙昊[4] 薛平[5] 刘威[6] 王琦[7] 张继军[8] 王雪峰[9] 王蒙[10] 邵英梅[11] 蔡开琳 侯森林[13] 张锎 李启勇[15,17] 张磊 朱克祥[1] 王海平[1] 张明[14] 孙向宇 杨智清[3] 陶杰 温子龙[5] 王群伟[6] 陈本栋[7] 王赢凯[8] 赵铭宁 张若岩[10] 蒋铁民[11] 刘科[12] 张立超 陈康杰[15] 朱晓亮[1] 张辉[16] 苗龙[1] 王正峰[1] 李佳佳[1] 闫晓雯 张凌恩 王芳昭 周文策 孟文勃[1] 李汛[1] Yue Ping;Wang Zhenyu;Zhang Leida;Sun Hao;Xue Ping;Liu Wei;Wang Qi;Zhang Jijun;Wang Xuefeng;Wang Meng;Shao Yingmei;Cai Kailin;Hou Senlin;Zhang Kai;Li Qiyong;Zhang Lei;Zhu Kexiang;Wang Haiping;Zhang Ming;Sun Xiangyu;Yang Zhiqing;Tao Jie;Wen Zilong;Wang Qunwei;Chen Bendong;Wang Yingkai;Zhao Mingning;Zhang Ruoyan;Jiang Tiemin;Liu Ke;Zhang Lichao;Chen Kangjie;Zhu Xiaoliang;Zhang Hui;Miao Long;Wang Zhengfeng;Li Jiajia;Yan Xiaowen;Zhang Ling'en;Wang Fangzhao;Zhou Wence;Meng Wenbo;Li Xun(Department of General Surgery,Institute of Hepatobiliary and Pancreatic Surgery of Gansu Province,the First Hospital of Lanzhou University,Lanzhou 730013,China;Minimally Invasive Surgery Center,Nankai Hospital of Tianjin,Tianjin 300100,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710061,China;Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China;Minimally Invasive Surgery Center,the Second Xiangya Hospital of Central Medical University,Changsha 410012,China;Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University,Yinchuan 750003,China;Department of General Surgery,General Hospital of Taiyuan Iron&Steel(Group)Co.,Ltd,Taiyuan 030008,China;Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China;Department of Hepatobiliary and Pancreatic Surgery,the First Hospital of Jilin University,Changchun 130061,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Biliary-Pancreatic and Endoscopic Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department

机构地区：[1]兰州大学第一医院普通外科甘肃省肝胆胰外科研究所,兰州730013 [2]天津市南开医院微创外科中心,天津300100 [3]陆军军医大学第一附属医院肝胆外科,重庆400038 [4]西安交通大学第一附属医院肝胆外科,西安710061 [5]广州医科大学附属第二医院肝胆外科,广州510260 [6]中南大学湘雅二医院微创外科中心,长沙410012 [7]宁夏医科大学总医院肝胆外科,银川750003 [8]太原钢铁(集团)有限公司总医院普通外科,太原030008 [9]上海交通大学医学院附属新华医院普通外科,上海200092 [10]吉林大学第一医院肝胆胰外科,长春130061 [11]新疆医科大学第一附属医院肝胆外科,乌鲁木齐830011 [12]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022 [13]河北医科大学第二医院胆胰内镜外科,石家庄050000 [14]山东省立第三医院肝胆外科,济南250031 [15]浙江大学医学院附属第一医院肝胆胰外科,杭州310009 [16]兰州大学第二医院普通外科,兰州730030 [17]树兰(杭州)医院

出　　处：《中华消化外科杂志》2023年第1期113-121,共9页Chinese Journal of Digestive Surgery

基　　金：甘肃自然科学基金(20JR10RA676);甘肃省省级引导科技创新发展专项资金竞争性项目(甘财科[2018]32号);兰州市城关区科技计划项目(2020JSCX0043)。

摘　　要：目的:探讨胆总管结石合并壶腹周围憩室(PAD)临床特征及行经内镜逆行胰胆管造影(ERCP)发生困难插管的影响因素。方法:采用回顾性病例对照研究方法。收集2015年7月至2017年12月我国兰州大学第一医院等15家医学中心收治的1920例行ERCP治疗胆总管结石患者的临床资料;男915例,女1005例;年龄为(63±16)岁。1920例患者中,228例合并PAD,1692例未合并PAD。观察指标:(1)胆总管结石患者临床特征。(2)胆总管结石患者行ERCP术中及术后情况。(3)胆总管结石患者行ERCP发生困难插管的影响因素分析。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(范围)或M(Q1,Q3)表示,组间比较采用Wilcoxon秩和检验。计数资料以绝对数或百分比表示,组间比较采用χ2检验或Fisher确切概率法。单因素及多因素分析采用Logistic回归模型。结果:(1)胆总管结石患者临床特征。合并PAD和未合并PAD胆总管结石患者年龄,体质量指数,合并症(慢性阻塞性肺疾病),胆总管直径,胆总管直径分类(<8 mm、8~12 mm、>12 mm),结石长径,结石数目(单发、多发)分别为(69±12)岁,(23.3±3.0)kg/m^(2),16例,(14±4)mm,11、95、122例,(12±4)mm,89、139例和(62±16)岁,(23.8±2.8)kg/m^(2),67例,(12±4)mm,159、892、641例,(10±4)mm,817、875例,两者上述指标比较,差异均有统计学意义(t=-7.55、2.45,χ^(2)=4.54,t=-4.92,Z=4.66,t=-7.31,χ2=6.90,P<0.05)。(2)胆总管结石患者行ERCP术中及术后情况。合并PAD和未合并PAD胆总管结石患者内镜下球囊扩张长径,术中出血,出血处理(黏膜下注射、止血夹、喷雾止血、电凝止血、其他),内镜下塑料支架置入,内镜下鼻胆管引流,机械碎石,取净结石,困难插管,延迟插管,>5次插管尝试,插管时间,X射线暴露时间,手术时间分别为10.0(8.5~12.0)mm,56例,6、5、43、1、1例,52例,177例,67例,201例,74例,38例,74例,(7.4±3.1)min,(6±3)min,(46±19)min和9.0Objective To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography(ERCP).Methods The retrospective case-control study was conducted.The clinical data of 1920 patients who underwent ERCP for choledocholithiasis in 15 medical centers,including the First Hospital of Lanzhou University,et al,from July 2015 to December 2017 were collected.There were 915 males and 1005 females,aged(63±16)years.Of 1920 patients,there were 228 cases with periampullary diverticulum and 1692 cases without periampullary diverticulum.Observation indicators:(1)clinical characteristics of patients with choledocholithiasis;(2)intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis;(3)influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(range)or M(Q1,Q3),and com-parison between groups was conducted using the Wilcoxon rank sum test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test or Fisher exact probability.The Logistic regression model was used for univariate and multivariate analyses.Results(1)Clinical characteristics of patients with choledocholithiasis.Age,body mass index,cases with complications as chronic obstructive pulmonary disease,diameter of common bile duct,cases with diameter of common bile duct as<8 mm,8‒12 mm,>12 mm,diameter of stone,cases with number of stones as single and multiple were(69±12)years,(23.3±3.0)kg/m^(2),16,(14±4)mm,11,95,122,(12±4)mm,89,139 in patients with choledocholithiasis combined with periampullary diverticulum,versus(62±16)years,(23.8±2.8)kg/m^(2),67,(12±4)mm,159,892,6

关 键 词：胆总管结石 壶腹周围憩室 经内镜逆行胰胆管造影 困难插管 并发症 影响因素 

分 类 号：R657.4[医药卫生—外科学]