内镜逆行胰胆管造影术后胰腺炎危险因素的Meta分析

Meta-analysis of risk factors for post endoscopic retrograde cholangiopancreatography pancreatitis

摘要:

目的 探讨引起内镜逆行胰胆管造影术后胰腺炎（PEP）的危险因素。方法 计算机检索中国知网、万方、维普、PubMed、Embase、Web of Science和Cochrane Library数据库，收集建库至2025年6月关于PEP危险因素的研究报道，对文献进行筛选和数据提取后，运用RevMan 5.4软件对提取的数据进行统计学分析。结果 共纳入53项回顾性研究。其中，英文文献24篇，中文文献29篇，共计81 129例患者，Meta分析结果表明：年龄 < 60岁（OR＾ = 1.54，95%CI：1.24～1.92）、胰腺炎病史（OR＾ = 3.21，95%CI：2.46～4.20）、内镜十二指肠乳头括约肌切开术（EST）（OR＾ = 1.42，95%CI：1.15～1.76）、术中胰管显影（OR＾ = 3.07，95%CI：2.58～3.65）、胆管插管困难（OR＾ = 3.04，95%CI：2.51～3.69）、奥迪括约肌功能障碍（SOD）（OR＾ = 3.42，95%CI：2.58～4.54）、术中球囊扩张（OR＾ = 1.61，95%CI：1.14～2.29）、PEP病史（OR＾ = 3.01，95%CI：1.43～6.34）和胰管支架置入（OR＾ = 1.66，95%CI：1.17～2.35）是发生PEP的独立危险因素；男性是发生PEP的保护因素（OR＾ = 0.70，95%CI：0.63～0.78）。结论 女性、年龄 < 60岁、胰腺炎病史、EST、术中胰管显影、胆管插管困难、SOD、术中球囊扩张、PEP病史和胰管支架置入是发生PEP的独立危险因素，术前应充分评估，术后应加强预防，尽可能地减少PEP的发生。

Abstract:

Objective To systematically identify and analyze the risk factors for post endoscopic retrograde cholangiopancreatography pancreatitis (PEP).Methods Electronic databases, including CNKI, Wanfang, VIP, PubMed, Embase, Web of Science, and the Cochrane Library, were systematically searched from inception to June 2025 for studies investigating risk factors for PEP. Following literature screening and data extraction, a meta-analysis was performed using RevMan 5.4 software.Results A total of 53 retrospective studies (24 in English, 29 in Chinese), involving 81,129 patients were included. Meta-analysis demonstrated that the following factors were significantly associated with an increased risk of PEP: age < 60 years (OR＾ = 1.54, 95%CI: 1.24 ~ 1.92), history of pancreatitis (OR＾ = 3.21, 95%CI: 2.46 ~ 4.20), endoscopic sphincterotomy (EST) (OR＾ = 1.42, 95%CI: 1.15 ~ 1.76), pancreatic duct opacification (OR＾ = 3.07, 95%CI: 2.58 ~ 3.65), difficult biliary cannulation (OR＾ = 3.04, 95%CI: 2.51 ~ 3.69), sphincter of Oddi dysfunction (SOD) (OR＾ = 3.42, 95%CI: 2.58 ~ 4.54), intraoperative balloon dilation (OR＾ = 1.61, 95%CI: 1.14 ~ 2.29), history of PEP (OR＾ = 3.01, 95%CI: 1.43 ~ 6.34), and pancreatic duct stent placement (OR＾ = 1.66, 95%CI: 1.17 ~ 2.35). In contrast, the male gender was identified as a protective factor (OR＾ = 0.70, 95%CI: 0.63 ~ 0.78).Conclusion Female, age < 60 years, history of pancreatitis, EST, pancreatic duct opacification, SOD, intraoperative balloon dilation, difficult biliary cannulation, and a history of PEP and pancreatic duct stent placement are independent risk factors for PEP. They should be fully evaluated before the operation, and prevention should be strengthened after the operation to minimize the occurrence of PEP as much as possible.