胆总管结石经内镜逆行胰胆管造影术后结石残留的危险因素分析

Analysis of Risk Factors of Residual Choledocholithiasis after Endoscopic Retrograde Cholangiopancreatography

目的探讨胆总管结石经ERCP术后结石残留的危险因素。方法回顾性分析2021年2月至2022年11月在江苏省中医院消化内镜中心行ERCP治疗的胆总管结石患者资料,收集可能与ERCP术后结石残留有关的危险因素进行单因素和多因素分析,寻找ERCP术后结石残留的独立危险因素。结果符合入组标准者331例,男177例、女154例,年龄最小19岁,最大95岁,中位年龄65岁。患者均痊愈出院,其中ERCP术后结石残留39例,结石残留患者比例为11.8%。单因素分析发现入院时患胆管炎、入院基线白细胞计数、中性粒细胞绝对值、碱性磷酸酶、直接胆红素、总胆红素水平、泥沙结石、结石数量≥3枚、结石最大径≥1.0 cm、术中行EST为ERCP术后结石残留的危险因素(P<0.05)。多因素分析显示结石数量≥3枚(OR=2.959,95%CI:1.277~6.855,P<0.05)、结石最大径≥1.0 cm(OR=3.627,95%CI:1.577~8.341,P<0.05)为ERCP术后结石残留的独立危险因素。结论当胆总管结石数量≥3枚或结石最大径≥1.0 cm时,ERCP术后更易出现结石残留,在这种情况下,辅以其他技术尤其碎石技术至关重要。

Objective To explore the risk factors of residual choledocholithiasis after ERCP.Methods The data of patients with choledocholithiasis treated with ERCP in the Digestive Endoscope Center of Jiangsu Province Hospital of Chinese Medicine from February 2021 to November 2022 were analyzed retrospectively.The risk factors that might be related to residual stones after ERCP were collected and analyzed by univariate and multivariate analysis to find out the independent risk factors of residual stones after ERCP.Results 331 patients met the admission criteria,including 177 males and 154 females,ranging from 19 to 95 years old,with a median age of 65 years.All the patients were cured and discharged,including 39 cases of residual stones after ERCP,and the proportion of patients with residual stones was 11.8%.Univariate analysis showed that cholangitis,baseline white blood cell count,absolute neutrophil count,alkaline phosphatase,direct bilirubin,total bilirubin,sediment stones,number of stones≥3,maximum diameter of stones≥1.0 cm and intraoperative EST were risk factors for residual stones after ERCP.Multivariate analysis showed that the number of stones≥3(OR=2.959,95%CI:1.277~6.855,P<0.05)and the maximum diameter of stones≥1.0 cm(OR=3.627,95%CI:1.577~8.341,P<0.05)were independent risk factors for residual stones after ERCP.Conclusion When the number of choledocholithiasis is more than 3 or the maximum diameter of stones is more than 1.0 cm,residual stones are more likely to occur after ERCP.In this case,other techniques,especially lithotripsy,are very important.