胆囊结石并发胆源性胰腺炎的高危因素分析

Analysis of High Risk Factors of Gallstones Complicated with Biliary Pancreatitis

目的研究胆囊结石并发胆源性胰腺炎(ABP)的高危因素.方法收集2014年1月1日至2017年9月30日收入某医科大学附属医院普外科确诊为胆囊结石的700名患者作为研究对象,收集整理其相关影像学检查、胆囊形态大小、胆囊壁厚度、胆囊结石数量及长径、是否合并胆总管结石、是否发生胆源性胰腺炎等数据,并对其相关因素进行单一因素及多因素Logistic回归分析.结果简略纳入分析的700例胆囊结石患者中共有167例并发ABP,发生率23.86%;单因素分析性别、胆囊形态大小、胆囊囊壁厚度、胆囊结石长径、胆囊结石数量、是否合并胆总管结石对是否并发ABP存在差异,且差异具有统计学意义P<0.05;年龄对是否并发ABP无统计学意义上的差异,P>0.05.对单一因素分析具有统计学差异的因素纳入二元Logistic回归分析中,进行多因素二元Logistic回归分析显示男性、胆囊形态大小正常、胆囊囊壁厚度≤3mm、胆囊结石长径≤1cm、胆囊多发结石、合并胆总管结石较对照组更易并发ABP,且差异具有统计学意义P<0.05.结论胆囊多发结石、合并胆总管结石并发胆源性胰腺炎的患者以男性患者为主,多伴有胆囊形态正常、胆囊结石长径≤1cm、胆囊壁厚≤3mm等因素特点.

Objective To study the high risk factors of gallstones complicated with cholestatic pancreatitis(ABP).Methods From January 1,2014 to September 30,2017,700 patients who were diagnosed as cholecystolithiasis in Department of general surgery,Affiliated Hospital of a medical university due to upper abdominal pain were examined for their related imaging and collected gallbladder The size of gallbladder,the number and long diameter of gallstones,the merger of common bile duct stones,the occurrence of biliary pancreatitis and other data,and its related factors for a single factor and multiple factors Logistic regression analysis.Results A total of 167 cases of bronchial calculi were included in the analysis of 167 cases with ABP,the incidence of 23.86%;The incidence of sex,the size of the gallbladder,the thickness of the gallbladder wall,the long diameter of the gallstones,the number of gallstones,the combination of common bile duct stones,and the incidence of gallstones,(P<0.05).There was no significant difference in age between the two groups(P>0.05).The difference was statistically significant(P>0.05).Multivariate logistic regression analysis showed that men with normal size,gallbladder wall thickness≤3mm,long diameter of gallstone≤1cm,gallstones with multiple stones,and the results were statistically different from the single factor analysis.Combined with common bile duct stones compared with the control group more complicated with ABP,and the difference was statistically significant P<0.05.A single factor analysis showed 305 cases of men in 93 cases(30.49%)with ABP,395 cases of women in 74 cases(18.73%(95%CI)=0.526(0.370-0.747),the difference was statistically significant;479 cases of age≥50 years old were 114 cases(23.80%),the difference was statistically significant;There were 53 cases(23.98%)with ABP in 221 patients with age<50 years old,andχ2=0.003 and P=0.958,the difference was not statistically significant;there were 39 cases of 280 cases of cholecystal enlargement or contraction(95%CI)=2.709(1.821-4.029),and the difference was significant(P<0.05),and there were 128 cases(30.48%)complicated with ABP in 420 cases of normal gallbladder.(17.74%)complicated with ABP,297 cases of gallbladder wall thickness≤3mm in 115 cases(28.26%)complicated with ABP,the two wereχ2=10.355,P value of 0.001,OR(95%CI)=0.548(0.379-0.793),the difference was statistically significant;194 cases of single gallstones in 20 cases(10.31%)complicated with ABP,50 There were 147 cases(29.05%)complicated with ABP in 6 cases of multiple stones,the difference wasχ2=27.117,P value 0.000,OR(95%CI)=3.562(2.159-5.879),the difference was statistically significant;559 cases of gallstones There were 149 cases(26.65%)with ABP in the long diameter≤1cm,and 18 cases(12.77%)with 141%of the diameter of the cholecystolithiasis were associated withχ2=11.957,P=0.001,OR(95%CI(42.86%)complicated with ABP,and 60 cases(20.76%)of the 602 cases without common bile duct stones were complicated with ABP,and the difference was statistically significant.The difference was statistically significant.The difference between the two groups wasχ2=22.646,P value 0.000,OR(95%CI)=0.349(0.224-0.546),the difference was statistically significant.The positive factor of single factor analysis was included in the multivariate binary logistic regression analysis model,showing genderχ2=10.349,P value 0.001,OR(95%CI)=1.879(1.279-2.758);gallbladder morphologyχ2=33.146,P(95%CI)=2.245(1.490-3.383);the size of cholecystolithiasisχ2=8.257,P(0.124-0.434);gallbladder wall thicknessχ2=14.958,P=0.000,OR(95%CI)=2.245(1.490-3.383)(95%CI)=2.775(1.694-4.546);whether or not combined with common bile duct stonesχ2=16.430(0.129-0.769);gallbladder stonesχ2=30.644,P=0.000,OR(95%CI)=2.775(1.694-4.546),P value 0.000,OR(95%CI)=2.775(1.694-4.546);the difference was statistically significant.Conclusion Male patients with gallbladder morphology,gallbladder wall thickness≤3mm,gallstones,gallstones,diameter of≤1cm,with choledocholithiasis are high risk factors of biliary pancreatitis.