摘要
目的探讨内窥镜下乳头括约肌切开术(EST)后胆囊切除术对胰腺炎患者复发及生存的影响。方法选择2010年1月至2015年12月榆林市第一医院行EST的胆总管结石合并胰腺炎患者560例,依据随访情况将患者分为胰腺炎复发组(180例)和未复发组(380例)。结合患者病情决定EST术后胆囊是否切除。采用Kaplan-Meier法和Cox比例风险回归模型进行单因素、多因素生存分析,确定影响胰腺炎患者累积复发率的危险因素,Log-Rank检验比较胆囊切除术对胰腺炎患者复发的影响差异。结果 560例胰腺炎患者接受EST术后,410例(73.2%)发生高淀粉酶血症,180例(32.1%)复发胰腺炎,其中轻、中、重度胰腺炎各占复发胰腺炎患者的70.0%(126/180)、20.0%(36/180)和10.0%(18/180)。年龄偏小、胰管显影、胆囊切除术、手术时间较长、黄疸、CCI评分较高、脑血管病、糖尿病、高血压、慢性肝病、肥胖症是影响胰腺炎患者接受EST术后复发的危险性因素(P<0.05)。胆囊切除的胰腺炎患者累积复发率和死亡率更低(P<0.05)。结论 EST术后胆囊切除术可降低胰腺炎患者胰腺炎复发率及死亡率,临床上应推广应用。
Objective To investigate the recurrence and survival of patients of choledocholithiasis combined with pancreatitis after endoscopic sphincterotomy（EST）. Methods From January 2010 to December 2015, five hundred and sixty patients with choledocholithiasis and pancreatitis in Yulin First Hospital of Shanxi underwent EST treatment. According to the recurrence of pancreatitis, the patients were divided into two groups： recurrent pancreatitis group（180 cases） and non-recurrent pancreatitis group（380 cases）. Depending on the patients＇ pancreatitis condition, the gallbladder was removed after EST operation. Univariate and multivariate survival analysis were performed using Kaplan-Meier and Cox proportional hazards regression model to determine the risk factors of cumulative recurrence rate in patients with pancreatitis. Log-Rank test was used to compared the difference of the cumulative recurrence rate. Results All the patients received EST, with 410（73.2%） cases of hyperamylasemia, 126（22.5%） recurrence of pancreatitis, 36（6.4%） recurrence of moderate acute pancreatitis and 18（3.2%） severe pancreatitis. Mild, moderate and severe pancreatitis accounted for 70.0%, 20.0% and 10.0% respectively of the total number of patients with recurrent pancreatitis. Young age, pancreatic duct opacification, cholecystectomy, long operation time, jaundice, higher CCI score, cerebral vascular disease, diabetes, hypertension, chronic liver disease, and obesity were the risk factors of recurrence of postoperative pancreatitis patients received EST（P〈0.05）. In addition, cumulative recurrence rate and mortality rate were lower in patients with cholecystectomy（P〈0.05）. Conclusion Cholecystectomy can reduce the recurrence rate and mortality of pancreatitis in patients with pancreatitis after EST, and it should be popularized and applied in clinic.
作者
李福荣
牛福勇
李华
Li Furong Niu Fuyong Li Hua(Department of Hepatobiliary Surgery, Yulin First Hospital of Shanxi, Yulin 719000, China Department of General Surgery, the Second Affiliated Hospital, Medical School of Xi ＇ an Jiaotong University, Xi ＇ an 710004, China)
出处
《中华普通外科学文献（电子版）》
2017年第4期255-259,共5页
Chinese Archives of General Surgery(Electronic Edition)
基金
陕西省自然科学基础研究计划项目(2012JQ4016)
西安交通大学基本科研业务费资助项目(Xjj2012072)
关键词
括约肌切开术
内窥镜
胆囊切除术
胰腺炎
复发
累积生存率
Sphincterotomy
endoscopic
Cholecystectomy
Pancreatitis
Recurrence
Cumulative survival rate
