经内镜逆行胰胆管造影术后并发胰腺炎的危险因素分析

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（X^2=9．715，P=0．002）、年龄〈60岁（X^2=6．108，P=0．013）、慢性胰腺炎（X^2=14．703，P=0．001）、初次ERCP（X^2=14．899，P=0．000）、高血压（X^2=4．489，P=0．034）、术前黄疸阴性（X^2=19．159，P=0．000）、困难插管（X^2=45．824，P=0．000）、留置胰管导丝（X^2=30．223，P=0．000）、乳头预切开（X^2=45．928，P=0．000）、胰管造影（X^2=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．ooo）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。

Analysis of risk factors for post-ERCP pancreatitis

Objective To investigate the risk factors of post-ERCP panereatitis （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 （X^2=9.715, P=0.002）, young （ 〈60 years）（X^2=6. 108, P=0.013）, chronic pancreatitis （X^2 = 14. 703, P = 0. 001 ）, initial ERCP 0（2 = 14. 899, P = 0. 000）, hypertension （X^2 = 4. 489, P = 0. 034）, nor- mal biliruhin levels before operation （X^2= 19. 159, P = 0. 000 ）, difficult cannulation （X^2 = 45. 824, P = 0. 000）, pancreatic guide wire （X^2=30. 223, P =0. 000）, papillary pre cut （X^2=45. 928, P =0. 000）, pun- creatography （X^2= 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 papinary 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 hilirubin levels, difficult cannulation, pancreatic duct guide wire, pa- pillary precut, pancreatography may induce P