内镜下十二指肠乳头括约肌切开取石术后胰腺炎影响因素分析

Analysis of influence factors of post-endoscopic sphincterotomy pancreatitis for choledocholithiasis

目的探讨胆总管结石内镜下十二指肠乳头切开取石术相关内镜逆行胰胆管造影术(ERCP)术后胰腺炎(PEP)的影响因素。方法回顾分析327例经内镜乳头切开取石术患者的临床资料,就患者的临床表现、伴随疾病、血生化、困难插管、胆总管扩张程度、胆总管结石大小及数量、乳头括约肌切开大小、鼻胆引流(ENBD)及术前用药等20余项指标进行统计学处理,寻找影响PEP的相关因素。结果 327例患者共发生PEP 23例(7.0%),单因素统计处理发现患者伴有胆囊结石、入院时血清总胆红素(TBIL)、直接胆红素(DBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、胆总管扩张程度PEP组和非PEP组比较P值小于或接近0.05,将这7项有可能影响PEP的指标纳入多因素分析,结果示胆囊结石和胆总管扩张程度是影响PEP发生的独立因素。结论伴有胆囊结石和胆总管不扩张或轻度扩张的胆总管结石患者,行内镜下乳头切开取石术较易并发PEP。

Objective To evaluate the infuence factors of post-ERCP pancreatitis （PEP）. Methods Clinical data of 327 patients underwent endoscopic sphincterotomy （EST） for management of choledocholithiasis was analyzed retrospectively. All the patients were divided into PEP group （23 cases） and non-PEP group （304 cases）. More than 20 indicators such as clinical manifestation, accompanying diseases, serum biochemical levels, diffcult cannulation, bile duct diameter, stone size and number, sphincterotomy size, ENBD, and premedication were statistically analyzed. Results The PEP rate was 7.0 %. Univariate analysis showed PEP seems to be associated with serum total bilirubin, direct bilirubin, alanine transaminase, aspartate transaminase, gamma-glutamyltransferase, triglyceride, bile duct diameter and cholecystolithiasis. Ultivariate logistic regression indicated only cholecystolithiasis and bile duct diameter are independent infuence factors of PEP. Conclusion EST patients with Cholecystolithiasis and normal or slight dilation of common bile duct are more likely to have post-ERCP pancreatitis.