中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (10): 1165-1170.DOI: 10.19538/j.cjps.issn1005-2208.2024.10.17

• 论著 • 上一篇    下一篇

内镜下逆行胰胆管造影术后非结石性急性胆囊炎风险因素分析

刘    振1，张    旭2，张保平1，赵进玉1，金伯儒1，钟汝阳1，林延延1，岳    平1，孟文勃1   

  1. 1兰州大学第一医院普外科，甘肃兰州 730030；2甘肃省人民医院内镜诊疗中心，甘肃兰州 730000
  • 出版日期:2024-10-01 发布日期:2024-10-24

  • Online:2024-10-01 Published:2024-10-24

摘要： 目的    分析内镜下逆行胰胆管造影（ERCP）术后非结石性急性胆囊炎（PEAAC）的影响因素及其发生时间特征。方法    回顾性分析2017年1月至2019年12月兰州大学第一医院普外科收治的因胆总管结石接受ERCP治疗的886例病人的临床资料。根据是否发生PEAAC分为PEAAC组（70例）和非PEAAC组（816例），采用Logistic回归分析ERCP术后PEAAC危险因素，并分析壶腹周围憩室（PAD）的Li-Tanaka分型与PEAAC发病关系，以及术后PEAAC发生时间特征。结果    单因素分析结果显示，机械碎石、内镜下管道塑料支架置入术（ERBD）、内镜下十二指肠乳头括约肌扩张术（EPBD）、内镜下鼻胆管引流术（ENBD）、PAD、胆囊壁粗糙、胆管扩张白细胞计数（WBC）、丙氨酸氨基转移酶（ALT）、中性粒细胞百分比、甘油三酯（TG）、胆固醇（CHOL）、高淀粉酶血症、CA19-9差异具有统计学意义（P＜0.05）。多因素分析显示，机械碎石、ERBD、PAD、胆囊壁粗糙、高淀粉酶血症、CA19-9升高是PEAAC发生的独立危险因素。PAD的Li-Tanaka分型中Ⅰ/Ⅱa型PAD病人PEAAC发生率为51.7%。PEAAC在术后不同时间段的发生率分别为：15 d内22例（2.5%），术后15~30 d内12例（1.4%），术后30~45 d 11例（1.2%），术后45~60 d及60~75 d均为9例（1.0%），术后75~90 d 7例（0.8%）。结论    机械碎石、ERBD、PAD、胆囊壁粗糙、高淀粉酶血症及CA19-9升高是PEAAC发生的独立危险因素，有助于临床预测PEAAC，ERCP术后1个月内应对具有上述危险因素的病人加强监测和管理。 

关键词: 内镜逆行胰胆管造影术, 急性非结石性胆囊炎, 壶腹周围憩室, 危险因素

Abstract: To analyze the influencing factors and temporal characteristics of post-endoscopic retrograde cholangiopancreatography acalculous acute cholecystitis (PEAAC) occurring after endoscopic retrograde cholangiopancreatography (ERCP). Methods    A retrospective analysis was conducted on the clinical data of 886 patients treated with ERCP for common bile duct stones at the Department of General Surgery, the First Hospital of Lanzhou University, from January 2017 to December 2019. Patients were divided into the PEAAC group (70 cases) and the non-PEAAC group (816 cases) based on the occurrence of PEAAC. Logistic regression analysis was used to identify the risk factors for PEAAC following ERCP. The relationship between the Li-Tanaka classification of peripapillary diverticula (PAD) and the onset of PEAAC, as well as the time characteristics of PEAAC onset post-surgery, were also analyzed. Results    Univariate analysis showed statistically significant differences in mechanical lithotripsy, endoscopic retrograde biliary drainage with plastic stent placement (ERBD), endoscopic papillary balloon dilatation (EPBD), endoscopic nasobiliary drainage (ENBD), PAD, gallbladder wall roughening, elevated white blood cell count (WBC), alanine aminotransferase(ALT), increased neutrophil percentage, triglycerides (TG), cholesterol (CHOL), hyperamylasemia, and  CA19-9 (P<0.05). Multivariate analysis indicated that mechanical lithotripsy, ERBD, PAD, gallbladder wall roughening, hyperamylasemia, and elevated CA19-9 were independent risk factors for PEAAC. In the Li-Tanaka classification of PAD, the incidence of PEAAC in patients with type Ⅰ and type Ⅱa PAD is 51.7%. The incidences of PEAAC at different time intervals post-ERCP are as follows: 22 cases (2.5%) within 15 days, 12 cases (1.4%) between 15 to 30 days, 11 cases (1.2%) between 30 to 45 days, 9 cases (1.0%) between 45 to 60 days, 9 cases (1.0%) between 60 to 75 days, and 7 cases (0.8%) between 75 to 90 days. Conclusion    Mechanical lithotripsy, ERBD, PAD, gallbladder wall roughening, hyperamylasemia, and elevated CA19-9 are independent risk factors for the occurrence of PEAAC and have significant clinical value in predicting PEAAC. Within one month after ERCP, patients with these risk factors should be closely monitored and managed.

Key words: endoscopic retrograde cholangiopancreatography, acute acalculous cholecystitis, peripapillary diverticula, risk factors