摘要
目的急性胆源性胰腺炎(acute biliary pancreatitis,ABP)为多因素综合所致,本文回顾分析胆囊结石继发肝外胆管结石病例的结石特点及胆管特征,以期了解ABP的危险因素及发病特点,为指导临床诊疗提供依据。方法回顾性分析内蒙古医科大学附属医院肝胆胰脾外科住院治疗的胆道结石患者病历资料,对合并ABP和不合并ABP患者的临床特点、实验室指标及影像学特点等多项参数综合分析、分组比较。结果合并ABP的胆囊结石继发肝外胆管结石患者共28例,包括轻症急性胰腺炎(mild acute pancreatitis,MAP)22例、中度重症急性胰腺炎(moderately severe acute pancreatitis,MSAP)3例和急性重症胰腺炎(sever eacutepancreatitis,SAP)3例,共1例(3.6%)患者死亡。Logistics二元回归分析提示,胆囊管直径≥5 mm、胆囊内最小结石<5 mm、胆囊内泥沙+块状结石及胰胆管合流异常四种因素与ABP发病高度相关(OR值分别为3.358、4.414、7.965和6.055)。结论胆囊管增粗、胆囊内泥沙和块状小结石混合、胰胆管合流异常,与ABP发病高度相关,这些因素将为今后ABP诊疗乃至预警提供依据。
Objective Acute biliary pancreatitis(ABP)is caused by multiple factors.The aim of this study was to retrospectively analyze the characteristics of gallstone and biliary duct in patients with gallstones secondary to extrahepatic bile duct stones,so as to understand the risk factors and pathogenesis of ABP,providing the evidence to guide clinical diagnosis and treatment.Methods Retrospective analysis of medical records of patients with biliary stones admitted to the Department of Hepatobiliary Pancreatic and Splenic Surgery,the Affiliated Hospital of Medical University.Comprehensive analysis and grouping comparison were performed on clinical characteristics,laboratory indicators,and imaging characteristics of patients with and without ABP.Results A total of 28 patients with gallstones secondary to extrahepatic bile duct stones were found to have ABP,including 22 with mild acute pancreatitis(MAP),3 with moderately severe acute pancreatitis(MSAP),and 3 with severe acute pancreatitis(SAP).One of 28 patients(3.6%)had a fatal outcome.Binary Logistics regression analysis revealed that diameter of cystic duct≥5 mm,diameter of the smallest gallbladder stone<5 mm,mixed stone in the gallbladder,and pancreaticobiliary maljunction(PBM)remained highly correlated with ABP(OR value:3.358,4.414,7.965 and 6.055,respectively).Conclusion The thickening of cystic duct,mixing of sediment and blocky small stones in the gallbladder,and pancreaticobiliary maljunction are strongly associated with the onset of ABP,which will provide evidence for the diagnosis,treatment and early warning of ABP in the future.
作者
杜军卫
靳君华
DU Jun-wei;JIN Jun-hua(Department of Hepatobiliary Surgery,the Affiliated Hospital of Inner Mongolia Medical University,Inner Mongolia,Hohhot 010050,China)
出处
《河北医科大学学报》
2023年第12期1448-1452,共5页
Journal of Hebei Medical University
关键词
胰腺炎
胆囊结石病
胆囊管直径
pancreatitis
cholecystolithiasis
diameter of cystic duct
