胃肠改道伴胆肠吻合术后内镜下逆行胰胆管造影失败影响因素的单因素分析

Univariate Analysis on Influencing Factors of Endoscopic Retrograde Cholangiopancreatography Failure After Gastrointestinal Reconstruction and Bilioenteric Anastomosis

目的探讨胃肠改道伴胆肠吻合术后内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)失败的影响因素。方法回顾性分析2005年1月~2021年12月我科80例Roux-en-Y和Whipple术后因胆系疾病行ERCP的临床资料,采用logistic回归分析胃肠改道伴胆肠吻合术后ERCP失败的影响因素。结果单因素分析显示因肿瘤手术治疗、术后多次ERCP、胃肠改道手术类型Roux-en-Y、保留胃和输入襻长度差异有显著性(P<0.05)。多因素logistic回归分析显示仅输入襻长度被纳入模型(OR=0.939,P=0.045)。将输入襻长度按≤45 cm、46~54 cm和≥55 cm进行分层,趋势χ2检验显示输入襻长度与ERCP失败风险存在剂量-反应关系(χ2趋势=7.587,P=0.006)。其中输入襻长度≥55 cm患者ERCP失败的风险是长度≤45 cm患者的40倍(OR=40.000,P=0.013),长度46~54 cm患者ERCP失败风险在二者之间。结论胃肠改道术伴胆肠吻合术后需行ERCP的患者,输入襻长度与ERCP失败风险存在剂量-反应关系,输入襻越长,ERCP失败风险越高。

Objective To explore factors of endoscopic retrograde cholangiopancreatography(ERCP)failure after gastrointestinal reconstruction and bilioenteric anastomosis.Methods Clinical data of 80 cases of ERCP due to biliary diseases after Roux-en-Y hepaticojejunostomy and Whipple operation from January 2005 to December 2021 in our department were analyzed retrospectively.The logistic regression was used to analyze the influencing factors of ERCP failure after gastrointestinal reconstruction and bilioenteric anastomosis.Results The univariate analysis showed that there were significant differences in surgery due to tumor,multiple ERCP after surgery,Roux-en-Y hepaticojejunostomy of gastrointestinal reconstruction,preservation of stomach,and the length of afferent loop(P<0.05).The multivariate logistic regression analysis showed that only the afferent loop length was included in the model(OR=0.939,P=0.045).The length of the afferent loop was hierarchically analyzed in groups of≤45 cm,46-54 cm and≥55 cm.The trendχ2 test showed that there was a dose-response relationship between the afferent loop length and the risk of ERCP failure(χ2 trend=7.587,P=0.006).The risk of ERCP failure in patients with afferent loop length≥55 cm was 40 times that of patients with length≤45 cm(OR=40.000,P=0.013),and the risk of ERCP failure in patients with length of 46-54 cm was between the two.Conclusions For patients who need ERCP after gastrointestinal reconstruction and bilioenteric anastomosis,there is a dose-response relationship between the length of afferent loop and the risk of ERCP failure.The longer the length of afferent loop,the higher the risk of ERCP failure.