CAJ | 학술논문

目的：探讨发生经内镜逆行胰胆管造影术（ ERCP）术后胰腺炎（ PEP）的危险因素。方法回顾性分析4234例接受ERCP诊疗患者的临床资料，提取患者年龄、性别、手术史、重大疾病史等基本信息以及术前实验室检查、腹部彩超、CT、磁共振胰胆管成像等检查结果，详细录入ERCP术中操作、术中诊断、并发症以及术后处理等情况，运用单因素分析和多因素分析手段分别寻找PEP发生的危险因素和独立危险因素，并采用矩阵相关分析方法探寻各危险因素之间是否存在共线性关系。结果共发生226例PEP，发生率为5.3%。单因素分析显示女性（χ2=9.715，P=0.002）、年龄<60岁（χ2=6.108，P =0.013）、慢性胰腺炎（χ2=14.703，P =0.001）、初次 ERCP（χ2=14.899，P =0.000）、高血压（χ2=4.489，P =0.034）、术前黄疸阴性（χ2=19.159，P =0.000）、困难插管（χ2=45.824，P=0.000）、留置胰管导丝（χ2=30.223，P=0.000）、乳头预切开（χ2=45.928，P=0.000）、胰管造影（χ2=20.170，P=0.000）为PEP发生的危险因素。多因素非条件Logistic回归分析显示女性（ OR=1.449，P =0.011）、初次 ERCP（ OR =1.745，P =0.003）、术前黄疸阴性（ OR =1.917，P =0.000）、困难插管（OR=3.317，P=0.000）以及胰管造影（OR=1.823，P=0.004）为PEP发生的独立危险因素。矩阵相关分析提示困难插管与乳头预切开、留置胰管导丝之间存在一定的共线性，相关系数分别为-0.788和-0.699。结论女性、年龄<60岁、慢性胰腺炎、初次ERCP、高血压、术前黄疸阴性、困难插管、留置胰管导丝、乳头预切开、胰管造影均可能引发PEP。其中术前黄疸阴性、初次ERCP、女性患者、困难插管和胰管造影是PEP的独立危险因素，而留置胰管导丝和乳头预切开因与困难插管密切相关，故不应当视为独立的危险因素。
목적：탐토발생경내경역행이담관조영술（ ERCP）술후이선염（ PEP）적위험인소。방법회고성분석4234례접수ERCP진료환자적림상자료，제취환자년령、성별、수술사、중대질병사등기본신식이급술전실험실검사、복부채초、CT、자공진이담관성상등검사결과，상세록입ERCP술중조작、술중진단、병발증이급술후처리등정황，운용단인소분석화다인소분석수단분별심조PEP발생적위험인소화독립위험인소，병채용구진상관분석방법탐심각위험인소지간시부존재공선성관계。결과공발생226례PEP，발생솔위5.3%。단인소분석현시녀성（χ2=9.715，P=0.002）、년령<60세（χ2=6.108，P =0.013）、만성이선염（χ2=14.703，P =0.001）、초차 ERCP（χ2=14.899，P =0.000）、고혈압（χ2=4.489，P =0.034）、술전황달음성（χ2=19.159，P =0.000）、곤난삽관（χ2=45.824，P=0.000）、류치이관도사（χ2=30.223，P=0.000）、유두예절개（χ2=45.928，P=0.000）、이관조영（χ2=20.170，P=0.000）위PEP발생적위험인소。다인소비조건Logistic회귀분석현시녀성（ OR=1.449，P =0.011）、초차 ERCP（ OR =1.745，P =0.003）、술전황달음성（ OR =1.917，P =0.000）、곤난삽관（OR=3.317，P=0.000）이급이관조영（OR=1.823，P=0.004）위PEP발생적독립위험인소。구진상관분석제시곤난삽관여유두예절개、류치이관도사지간존재일정적공선성，상관계수분별위-0.788화-0.699。결론녀성、년령<60세、만성이선염、초차ERCP、고혈압、술전황달음성、곤난삽관、류치이관도사、유두예절개、이관조영균가능인발PEP。기중술전황달음성、초차ERCP、녀성환자、곤난삽관화이관조영시PEP적독립위험인소，이류치이관도사화유두예절개인여곤난삽관밀절상관，고불응당시위독립적위험인소。
Objective To investigate the risk factors of post-ERCP pancreatitis( PEP). Methods Data of 4,234 patients who underwent ERCP in Nanjing Drum Tower Hospital were retrospectively analysed. Information of patients and operations,including age,gender,operation history,major disease history,labora-tory examination before operation,abdominal ultrasound,CT,MRCP,detailed ERCP operation process,com-plications and treatment were carefully recorded. Then Chi-square test was used for univariate analysis,and stepwise multivariate Logistic regression for variate analysis. Linear correlations between risk factors were de-tected. Results There were totally 226 PEPs,with 5. 3% incidence rate. Univariate analysis showed that the female(χ2 =9. 715,P=0. 002),young( <60 years)(χ2 =6. 108,P=0. 013),chronic pancreatitis(χ2 =14. 703,P=0. 001),initial ERCP(χ2 =14. 899,P=0. 000),hypertension(χ2 =4. 489,P=0. 034),nor-mal bilirubin levels before operation(χ2 =19. 159,P =0. 000 ),difficult cannulation(χ2 =45. 824,P =0. 000),pancreatic guide wire(χ2 =30. 223,P=0. 000),papillary pre cut(χ2 =45. 928,P=0. 000),pan-creatography(χ2 =20. 170,P=0. 000)may be risk factors for PEP. Non conditional Logistic regression analy-sis showed that female(OR=1. 449,P=0. 011),initial ERCP(OR=1. 745,P=0. 003),normal bilirubin levels before operation(OR=1. 917,P=0. 000),difficult cannulation(OR=3. 317,P=0. 000)and pancre-atography(OR=1. 823,P=0. 004)were independent risk factors for PEP. Linear correlation analysis sugges-ted that pancreatic duct guide wire and papillary precut were related to the difficult cannulation,and the corre-lation coefficients were -0. 788 and -0. 699. Conclusion Female,young(<60 years),chronic pancreati-tis,initial ERCP,hypertension,normal bilirubin levels,difficult cannulation,pancreatic duct guide wire,pa-pillary precut,pancreatography may induce PEP. Female,normal bilirubin levels before operation,initial ER-CP,difficult cannulation and pancreatography are independent risk factors for PEP,while pancreatic duct guide wire,papillary precut are not,as they were linear correlated to difficult cannulation.