胆总管结石患者内镜逆行胰胆管造影术后复发的影响因素分析

Analysis of influencing factors of recurrence after endoscopic retrograde cholangiopancreatography in patients with calculus of the common bile duct

摘要:

目的 分析胆总管结石患者内镜逆行胰胆管造影术（ERCP）后复发的影响因素，并构建回归方程，分析其预测价值，以期为术后复发的预防提供参考依据。方法 收集2020年1月－2024年3月该院收治的行ERCP的胆总管结石患者256例，所有患者均随访1年，根据是否复发，将其分为复发组（53例）和未复发组（203例）。采用单因素和多因素Logistic回归模型，分析胆总管结石患者ERCP后复发的独立危险因素，并构建回归方程，分析其对患者术后复发的预测价值。结果 有胆囊切除史（OR＾ = 1.758，95%CI：1.096～2.819）、胆总管直径 ≥ 15 mm（OR＾ = 2.056，95%CI：1.042～4.060）、胆道狭窄（OR＾ = 1.626，95%CI：1.084～2.439）、乳头旁憩室（OR＾ = 1.885，95%CI：1.009～3.523）、结石数目 ≥ 3个（OR＾ = 1.694，95%CI：1.103～2.602）、乳头括约肌切开（OR＾ = 1.904，95%CI：1.033～3.510）和术后胆胰管支架引流（OR＾ = 1.800，95%CI：1.120～2.893）是胆总管结石患者ERCP后复发的独立危险因素（P < 0.05）。回归方程：Logit（P） = -8.977+胆囊切除史×0.564+胆总管直径 ≥ 15 mm×0.721+胆道狭窄×0.486+乳头旁憩室×0.634+结石数目 ≥ 3个×0.527+乳头括约肌切开×0.644+术后胆胰管支架引流×0.588（P < 0.05）。当Logit（P） > 0.26时，曲线下面积（AUC）为0.860，敏感度为81.13%，特异度为81.28%（95%CI：0.811～0.900）。结论 胆总管结石患者ERCP后复发的危险因素有：胆囊切除史、胆总管直径 ≥ 15 mm、胆道狭窄、乳头旁憩室、结石数目 ≥ 3个、乳头括约肌切开和术后胆胰管支架引流。临床应引起重视。

Abstract:

Objective To analyze the influencing factors of recurrence after endoscopic retrograde cholangiopancreatography (ERCP) in patients with calculus of the common bile duct, and to construct a regression equation to analyze its predictive value, so as to provide a reference for the prevention of postoperative recurrence.Methods A total of 256 patients with calculus of the common bile duct who underwent ERCP in this hospital from January 2020 to March 2024 were collected. All patients were followed up for one year. According to whether there was recurrence, they were divided into the recurrence group (53 cases) and the non-recurrence group (203 cases). Univariate and multivariate logistic regression models were used to analyze the independent risk factors for recurrence after ERCP in patients with calculus of the common bile duct, and regression equation was constructed to analyze their predictive value for postoperative recurrence in patients.Results History of cholecystectomy (OR＾ = 1.758, 95% CI: 1.096~2.819), common bile duct diameter ≥ 15 mm (OR＾ = 2.056, 95%CI: 1.042 ~ 4.060), biliary stricture (OR＾ = 1.626, 95%CI: 1.084 ~ 2.439), parapillary diverticulum (OR＾ = 1.885, 95%CI: 1.009 ~ 3.523), number of stones ≥ 3 (OR＾ = 1.694, 95%CI: 1.103 ~ 2.602), papillary sphincterotomy (OR＾ = 1.904, 95%CI: 1.033 ~ 3.510) and the postoperative drainage method of biliary and pancreatic duct stent (OR＾ = 1.800, 95%CI: 1.120 ~ 2.893) were independent risk factors for recurrence after ERCP in calculus of common bile duct patients (P < 0.05). Regression equation: Logit (P) = 8.977 + history of cholecystectomy × 0.564 + common bile duct diameter ≥ 15 mm × 0.721 + biliary stricture × 0.486 + parapapillary diverticulum × 0.634 + number of stones ≥ 3 × 0.527 + papillary sphincterotomy × 0.644 + postoperative drainage method of biliary and pancreatic duct stent × 0.588 (P < 0.05). When logit (P) > 0.26, the area under the curve (AUC) was 0.860, the sensitivity was 81.13%, and the specificity was 81.28% (95%CI: 0.811~0.900).Conclusion The risk factors for recurrence after ERCP in patients with calculus of the common bile duct include a history of cholecystectomy, a common bile duct diameter of ≥ 15 mm, biliary stricture, a parapillary diverticulum, a number of stones ≥ 3, the papillary sphincterocomy, and the postoperative drainage method being biliary and pancreatic duct stents. Clinical attention should be paid.