摘要
目的分析胆管支架置入(ERBD)术后肠内容物反流至胆道的相关因素。方法回顾性纳入2019年3月至2024年10月在同济大学附属东方医院胆石病中心行经内镜逆行胰胆管造影(ERCP)取出胆管支架并行胆道内清理的620例患者。根据有无食糜纤维素反流至胆道分为病例组和对照组, 收集所有患者的临床资料, 采用单因素及多因素logistic回归模型分析ERBD术后肠内容物反流至胆道的相关因素。结果共纳入620例患者, 对照组397例, 年龄[M(Q1, Q3)]61.0(51.0, 71.0)岁, 男198例;病例组223例, 年龄62.0(51.0, 70.0)岁, 男89例。对照组ERBD时长[3.0(2.1, 3.5)比2.6(1.8, 3.2)个月]、男性患者[49.9%(198/397)比39.9%(89/223)]、既往ERCP手术史[16.4%(65/397)比10.3%(23/223)]及高血压比例[36.0%(143/397)比26.5%(59/223)]均高于病例组(均P>0.05)。病例组中胆胰合流异常(PBM)比例高于对照组[10.8%(24/223)比4.8%(19/397), P=0.005]。病例组中内镜下十二指肠乳头括约肌切开术(EST)[82.5%(184/223)比75.3%(299/397)]和内镜下乳头球状气囊扩张术(EPBD)[94.5%(207/223)比87.1%(343/397)]比例均高于对照组(均P<0.05);对照组ERBD总数量[10.1%(40/397)比4.9%(11/223)]比例高于病例组(P=0.023)。多因素logistic回归模型分析显示, PBM(OR=2.00, 95%CI:1.05~3.81)、女性(OR=1.45, 95%CI:1.02~2.07)、ERBD时长(OR=0.87, 95%CI:0.80~0.96)及高血压(OR=0.61, 95%CI:0.42~0.89)是ERBD术后肠内容物反流至胆道的相关因素。结论女性和PBM是ERBD术后肠内容物反流至胆道的相关因素。
Objective:To analyze the related factors for intestinal contents refluxing into the biliary tract following endoscopic retrograde biliary drainage(ERBD).Methods:A total of 620 patients who underwent endoscopic retrograde cholangiopancreatography(ERCP)to remove biliary stents and perform biliary tract cleaning at the Shanghai East Hospital Gallstone Disease Center from March 2019 to October 2024 were included in this study.Patients were divided into a case group and a control group based on the presence or absence of chyme-fibrin reflux into the biliary tract.Clinical data were collected for all patients,and univariate and multivariate logistic regression analyses were performed to identify related factors for intestinal contents reflux into the biliary tract.Results:A total of 620 patients were included:397 in the control group,aged 61.0(51.0,71.0)years,with 198 males;and 223 in the case group,aged 62.0(51.0,70.0)years,with 89 males.The control group had a longer duration of biliary stent placement[3.0(2.1,3.5)vs 2.6(1.8,3.2)months],a higher proportion of male patients[49.9%(198/397)vs 39.9%(89/223)],history of ERCP procedures[16.4%(65/397)vs 10.3%(23/223)],and hypertension[36.0%(143/397)vs 26.5%(59/223)]compared with the case group(all P>0.05).The proportion of pancreaticobiliary maljunction(PBM)in the case group was higher than that in the control group[10.8%(24/223)vs 4.8%(19/397),P=0.005].The incidence of endoscopic sphincterotomy(EST)[82.5%(184/223)vs 75.3%(299/397)]and endoscopic papillary balloon dilatation(EPBD)[94.5%(207/223)vs 87.1%(343/397)]was higher in the case group than in the control group(both P<0.05);the total number of biliary stents placed was higher in the control group(10.1%vs 4.9%)than in the case group(P=0.023).Multivariate logistic regression analysis identified PBM(OR=2.00,95%CI:1.05-3.81),female gender(OR=1.45,95%CI:1.02-2.07),duration of biliary stent placement(OR=0.87,95%CI:0.80-0.96)and hypertension(OR=0.61,95%CI:0.42-0.89)as related factors for post-ERBD intestinal contents reflux into the biliary tract.Conclusion:Female gender and PBM are related factors for post-ERBD intestinal contents reflux into the biliary tract.
作者
张红雷
张诚
邱晨
张博森
黄安华
胡海
杨玉龙
Zhang Honglei;Zhang Cheng;Qiu Chen;Zhang Bosen;Huang Anhua;Hu Hai;Yang Yulong(Center of Gallbladder Disease,Shanghai East Hospital,Institute of Gallstone Disease,School of Medicine,Tongji University,Shanghai 200120,China)
出处
《中华医学杂志》
北大核心
2025年第44期4081-4087,共7页
National Medical Journal of China
基金
浦东新区临床特色学科基金(PWYts2021-06)
上海市浦东新区卫生系统重点专科建设资助(PWZzk2022-17)
上海市东方医院临床研究项目(DFLC2022019)
上海市东方医院科研启动基金(DFRC2018014)
上海市东方医院重点学科胆石病科(2024-DFZD-005DS)。
