高危老年胆总管大结石患者塑料胆管支架置入后支架堵塞的影响因素分析

Factors influencing stent occlusion after endoscopic placement of a biliary plastic stent in high-risk elderly patients with large common bile duct stones

目的探讨合并慢性病的高危老年胆总管大结石患者,经塑料胆管支架置入治疗后影响支架堵塞的危险因素。方法回顾性分析2016年1月至2024年3月因胆总管大结石在解放军总医院第一医学中心行ERCP下塑料胆管支架置入治疗的高危老年患者资料,所有患者均随访3个月并在3个月内行第二次ERCP治疗。根据患者是否出现支架堵塞将患者分为堵塞组和通畅组。比较两组间的一般资料、化验结果、结石大小、是否存在壶腹周围憩室、支架种类和直径等指标,采用多因素logistics回归分析评估影响塑料胆管支架堵塞的危险因素。结果共入组111例患者,其中堵塞组28例,通畅组83例,支架堵塞率为25.23%。单因素分析示术前白细胞计数、丙氨酸氨基转移酶、壶腹周围憩室、支架直径在两组之间比较,差异有统计学意义(P值均<0.05)。多因素logistics回归分析显示,WBC[OR(95%CI):1.209(1.074~1.361)]、支架直径[OR(95%CI):0.279(0.088~0.887)]、壶腹周围憩室[OR(95%CI):3.396(1.077~10.710)]是术后支架堵塞的独立危险因素(P值均<0.05)。结论术前白细胞计数升高及存在壶腹周围憩室的患者术后发生支架堵塞的风险高,直径更大的胆管支架可有效降低术后支架堵塞的风险。

Objective To identify factors that influence stent obstruction after endoscopic placement of a biliary plastic stent in high-risk elderly patients with large common bile duct stones.Methods The data of high-risk elderly patients who received endoscopic placement of a biliary plastic stent for large common bile duct stones from January 2016 to March 2024 were retrospectively analyzed.All patients were followed up for 3 months and received a second ERCP within 3 months.The patients were divided into obstruction group and patency group.The baseline data,laboratory test results,stone size,type of stent,diameter of stent and periampullary diverticula(PAD)were compared between two groups.The multivariate logistic regression analysis was conducted to identify factors that influence stent occlusion.Results A total of 111 patients were enrolled,of which 28 were in the obstruction group and 83 in the patency group,with a stent occlusion rate of 25.23%.White blood cell(WBC),Alanine transaminase(ALT),diameter of stent and PAD were found to be significant on univariate analysis.The multivariate logistic regression analysis indicated that WBC(OR 1.209,95%CI 1.074-1.361),diameter of stent(OR 0.279,95%CI 0.088-0.887)and PAD(OR 3.396,95%CI 1.077-10.710)were independent risk factors for stent occlusion.Conclusion Patients with preoperative elevated WBC and periampullary diverticula have a high risk of stent occlusion,and stents larger in diameter exhibit later onset of clogging.