十二指肠镜下胆总管取石术后发生胰腺炎的影响因素分析

doi:10.11958/20240978

摘要/Abstract

摘要：

目的探讨十二指肠镜下胆总管取石术（DCBDSR）术后发生胰腺炎的影响因素。方法纳入行DCBDSR的患者387例，依据是否发生胰腺炎分为胰腺炎组36例和无胰腺炎组351例。比较2组一般资料及实验室指标差异，Logistic回归分析DCBDSR术后发生胰腺炎的影响因素。结果与无胰腺炎组比较，胰腺炎组年龄小，合并高血压、合并高脂血症及胰腺病史比例高，平均插管次数多（P<0.05），2组性别、体质量指数、饮酒史、吸烟史、合并糖尿病、结石数量、结石直径、手术时间、造影次数、天冬氨酸转氨酶、谷氨酰转肽酶、丙氨酸转氨酶、直接胆红素和总胆红素水平比较差异均无统计学意义（P>0.05）。Logistic回归结果显示，低龄、合并高血压、合并高脂血症、胰腺病史和插管次数较多为影响DCBDSR术后发生胰腺炎的独立危险因素。结论低龄、合并高血压、合并高脂血症、胰腺病史及插管次数多是十二指肠镜下胆总管取石术后发生胰腺炎的危险因素。

关键词: 胆石, 胰腺炎, 十二指肠镜, 影响因素分析, 胆总管取石术

Abstract:

Objective To explore the influencing factors of pancreatitis after duodenoscopic common bile duct stone removal surgery (DCBDSR). Methods A total of 387 patients with DCBDSR were included in this study. Patients were divided into the pancreatitis group (36 cases) and the non-pancreatitis group (351 cases). General data and laboratory indexes were compared between the two groups. The influencing factors of postoperative pancreatitis after DCBDSR were analyzed by regression analysis. Results Compared with the non-pancreatitis group, the pancreatitis group had a younger age, a higher proportion of hypertension, hyperlipidemia and pancreatic history, and a higher average number of intubations (P < 0.05). There were no significant differences in gender, body mass index, drinking history, smoking history, diabetes, gallbladder size, number of stones, stone diameter, operation time, number of angiography, aspartate aminotransferase (AST), glutamyl transpeptidase (GTP), alanine aminotransferase (ALT), direct bilirubin (DBIL) and total bilirubin (TBIL) levels between the two groups (P>0.05). Young age, combined hypertension, concomitant hyperlipidemia, history of pancreatic disease and frequent intubation were independent risk factors for postoperative pancreatitis after DCBDSR. Conclusion Young age, concomitant hypertension, concomitant hyperlipidemia, history of pancreatic disease and frequent intubation are risk factors for developing pancreatitis after DCBDSR.

Key words: gallstones, pancreatitis, duodenoscopes, root cause analysis, common bile duct stone surgery

中图分类号:

R576，R575.6

图/表 3

参考文献 11

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组别		n	男性		年龄/岁		BMI/（kg/m²）		饮酒史		吸烟史		合并高血压		合并糖尿病
无胰腺炎组		351	200（57.0）		42.72±6.23		21.92±2.34		78（22.2）		104（29.6）		27（7.7）		37（10.5）
胰腺炎组		36	23（63.9）		38.97±5.81		22.31±2.65		10（27.8）		13（36.1）		24（66.7）		8（22.2）
χ²或t			0.638		3.460^＊＊		0.940		1.433		0.650		94.164^＊＊		3.273
组别	合并高脂血症			结石数量/枚		结石直径/cm		胰腺病史		手术时间/min		造影次数/次		插管次数/次
无胰腺炎组	56（15.9）			2.43±0.78		1.19±0.32		13（3.7）		94.52±28.97		2.28±0.56		1.97±0.65
胰腺炎组	22（61.1）			2.54±0.61		1.24±0.35		15（41.7）		98.87±21.26		2.37±0.48		3.18±0.42
χ²或t	41.373^＊＊			0.821		0.885		64.569^＊＊		0.877		0.930		10.930^＊＊

组别		n	男性		年龄/岁		BMI/（kg/m²）		饮酒史		吸烟史		合并高血压		合并糖尿病
无胰腺炎组		351	200（57.0）		42.72±6.23		21.92±2.34		78（22.2）		104（29.6）		27（7.7）		37（10.5）
胰腺炎组		36	23（63.9）		38.97±5.81		22.31±2.65		10（27.8）		13（36.1）		24（66.7）		8（22.2）
χ²或t			0.638		3.460^＊＊		0.940		1.433		0.650		94.164^＊＊		3.273
组别	合并高脂血症			结石数量/枚		结石直径/cm		胰腺病史		手术时间/min		造影次数/次		插管次数/次
无胰腺炎组	56（15.9）			2.43±0.78		1.19±0.32		13（3.7）		94.52±28.97		2.28±0.56		1.97±0.65
胰腺炎组	22（61.1）			2.54±0.61		1.24±0.35		15（41.7）		98.87±21.26		2.37±0.48		3.18±0.42
χ²或t	41.373^＊＊			0.821		0.885		64.569^＊＊		0.877		0.930		10.930^＊＊

组别	n	AST/（U/L）	GTP/（U/L）	ALT/（U/L）	DBIL/（μmol/L）	TBIL/（μmol/L）
无胰腺炎组	351	39.94±12.13	164.92±58.49	81.98±26.14	8.19±2.34	19.97±4.76
胰腺炎组	36	43.24±13.76	175.24±43.52	89.96±23.21	8.74±2.56	20.81±4.53
t		1.535	1.029	1.761	1.331	1.013

组别	n	AST/（U/L）	GTP/（U/L）	ALT/（U/L）	DBIL/（μmol/L）	TBIL/（μmol/L）
无胰腺炎组	351	39.94±12.13	164.92±58.49	81.98±26.14	8.19±2.34	19.97±4.76
胰腺炎组	36	43.24±13.76	175.24±43.52	89.96±23.21	8.74±2.56	20.81±4.53
t		1.535	1.029	1.761	1.331	1.013

因素	β	SE	Wald χ²	P	OR	OR 95%CI
年龄	-0.114	0.047	5.980	0.014	0.892	0.814~0.978
高血压	1.978	0.796	6.172	0.013	7.227	1.518~34.403
高脂血症	2.352	0.748	9.885	0.002	10.504	2.425~45.502
胰腺病史	3.975	1.365	8.486	0.004	53.253	3.671~772.455
插管次数	5.195	1.424	13.300	<0.001	180.327	11.056~2 941.200
常数项	-13.732	4.369	9.881	0.002	<0.001