| 王 鸣,朱海兰,吴 诚,李明阳,石 卉.老年胆总管结石患者ERCP治疗前后炎性因子、免疫功能的变化及术后并发胰腺炎的危险因素研究[J].,2022,(12):2265-2269 |
| 老年胆总管结石患者ERCP治疗前后炎性因子、免疫功能的变化及术后并发胰腺炎的危险因素研究 |
| Changes of Inflammatory Factors, Immune Function and Risk Factors Study of Postoperative Concurrent Pancreatitis in Elderly Patients with Choledocholithiasis before and after ERCP Treatment |
| 投稿时间：2021-11-27 修订日期：2021-12-23 |
| DOI：10.13241/j.cnki.pmb.2022.12.013 |
| 中文关键词: 老年 胆总管结石 经内镜逆行胰胆管造影术 炎性因子 免疫功能 胰腺炎 危险因素 |
| 英文关键词: Elderly Choledocholithiasis Endoscopic retrograde cholangiopancreatography Inflammatory factors Immune function Pancreatitis Risk factors |
| 基金项目:北京市科技计划项目（Z171100004015206） |
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| 中文摘要: |
| 摘要 目的：观察老年胆总管结石患者经内镜逆行胰胆管造影术（ERCP）治疗后，炎性因子、免疫功能的变化，并分析术后并发胰腺炎的危险因素。方法：纳入2015年3月~2021年5月期间来我院接受治疗的老年胆总管结石患者250例，均接受ERCP治疗，观察治疗前后炎性因子、免疫功能的变化，记录两组一次性取石成功率、术中出血量、手术时间、住院时间及术后并发症发生率。采用多因素Logistic回归分析术后并发胰腺炎的危险因素。结果：本次研究纳入的患者一次性取石成功率为96.80%（242/250），术中出血量（16.57±1.34）ml，手术时间（46.38±5.19）min，住院时间（8.82±1.35）d。术后并发症发生率12.80%（32/250）。治疗后，患者的CD3+、CD4+、CD4+/CD8+较治疗前升高，CD8+较治疗前下降（P<0.05）。治疗后，患者的血清白介素-6（IL-6）、C反应蛋白（CRP）和肿瘤坏死因子-α（TNF-α）水平较治疗前下降（P<0.05）。按照ERCP术后是否并发胰腺炎进行分组，其中26例发生胰腺炎的患者纳为并发组，未并发胰腺炎的224例纳为未并发组。单因素分析结果显示，ERCP术后并发胰腺炎与胰管显影、性别、胆总管结石病史、体质量指数（BMI）、Oddi括约肌功能障碍（SOD）病史、ERCP手术时间、多次插管、胰腺炎病史、导丝进入胰管、阻塞性黄疸有关（P<0.05）。多因素Logistic回归分析结果显示：SOD病史、性别为女、BMI≥30 kg/m2、胰腺炎病史、ERCP手术时间≥60 min、多次插管、胰管显影是ERCP术后并发胰腺炎的危险因素（P<0.05）。结论：ERCP治疗老年胆总管结石患者，疗效显著，术中出血量少，患者术后恢复较快，但患者术后有一定的并发症发生，主要以胰腺炎为主。且术后并发胰腺炎的危险因素较多，可采取适当措施改进操作环节，减少术后胰腺炎的发生。 |
| 英文摘要: |
| ABSTRACT Objective: To observe the changes of inflammatory factors and immune function in elderly patients with choledocholithiasis after endoscopic retrograde cholangiopancreatography (ERCP) treatment, and to analyze the risk factors of postoperative concurrent pancreatitis. Methods: 250 elderly patients with choledocholithiasis who were treated in our hospital from March 2015 to May 2021 were included. They were treated with ERCP. The changes of inflammatory factors and immune function before and after treatment were observed. The success rate of one-time stone removal, intraoperative blood loss, operation time, hospital stay and incidence of postoperative complications of two groups were recorded. Multivariate Logistic regression was used to analyze the risk factors of postoperative concurrent pancreatitis. Results: In the patients included in this study, the success rate of one-time stone removal was 96.80% (242/250), the intraoperative blood loss was (16.57±1.34)mL, the operation time was (46.38±5.19)min, and the hospital stay was (8.82±1.35)d. The incidence of postoperative complications was 12.80% (32/250). After treatment, CD3+, CD4+, CD4+/CD8+ of patients were higher than those before treatment, while CD8+ was lower than that before treatment (P<0.05). After treatment, the levels of serum interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) were decreased compared with those before treatment (P<0.05). According to whether concurrent pancreatitis postoperative ERCP, 26 patients with pancreatitis were classified into the concurrent group, and 224 patients without pancreatitis were classified into the non-concurrent group. Univariate analysis showed that concurrent pancreatitis postoperative ERCP were associated with pancreatic duct imaging, gender, choledocholithiasis history, body mass index (BMI), Oddi sphincter dysfunction (SOD) history, ERCP operation time, multiple intubations, pancreatitis history, guidewire entry into the pancreatic duct and obstructive jaundice (P<0.05). Multivariate Logistic regression analysis showed that SOD history, gender was female, BMI≥30 kg/m2, pancreatitis history, ERCP operation time ≥60 min, multiple intubations, pancreatic duct imaging were the risk factors for concurrent pancreatitis postoperative ERCP (P<0.05). Conclusion: ERCP treatment for elderly patients with choledocholithiasis has significant efficacy, with less intraoperative blood loss, and faster postoperative recovery of patients. However, there are certain postoperative complications, mainly pancreatitis. There are many risk factors for postoperative occurrence pancreatitis, so appropriate measures can be taken to improve the operation process and reduce the occurrence of postoperative pancreatitis. |
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