鼻胆管造影对经内镜逆行胰胆管造影取石术后结石残留的诊断价值及结石残留相关因素分析

目的评价经鼻胆管造影对经内镜逆行胰胆管造影(ERCP)术后残留胆总管结石的诊断价值,分析残留结石的相关危险因素。方法回顾性分析2018年1月1日—2019年12月31日在北京大学第一医院完成ERCP取石及内镜下鼻胆管引流术后鼻胆管造影的病例资料。计数资料组间比较采用χ²检验。运用logistic回归分析结石残留的独立危险因素。结果366例患者完成ERCP取石及鼻胆管造影,27例可疑残留结石,再次ERCP证实其中25例为结石残留(残留组),另341例无残留(无残留组)。ERCP胆管取石后结石残留率为6.8%(25/366),鼻胆管造影对胆总管残留结石的阳性预测值为92.6%(25/27)。单因素分析结果显示:多发结石、胆总管直径≥1.5cm、机械碎石在两组间的差异有统计学意义(χ²值分别为5.014、7.651、9.670,P值均<0.05)。多因素logistic回归分析显示,多发结石(OR=2.713,95%CI:1.002~7.345,P=0.049)、机械碎石(OR=9.183,95%CI:2.347~35.925,P=0.001)是结石残留的独立危险因素。结论术后鼻胆管造影是发现胆总管残留结石的有效手段。多发结石和术中使用机械碎石是结石残留的独立危险因素。

Value of nasobiliary cholangiography in the diagnosis of residual common bile duct stones after endoscopic retrograde cholangiopancreatography and related factors of residual common bile duct stones

Objective To investigate the value of nasobiliary cholangiography in the diagnosis of residual common bile duct stones after endoscopic retrograde cholangiopancreatography(ERCP)and the risk factors for residual stones.Methods A retrospective analysis was performed for the clinical data of the patients who underwent ERCP and nasobiliary cholangiography after endoscopic nasobiliary drainage in Peking University First Hospital from January 1,2018 to December 31,2019.The chi-square test was used for comparison of categorical data between groups,and a logistic regression analysis was used to investigate independent risk factors for residual stones.Results A total of 366 patients underwent ERCP and nasobiliary cholangiography and 27 patients were suspected to have residual stones,among whom 25 had residual stones confirmed by ERCP.The rate of residual stones after ERCP was 6.8%(25/366),and nasobiliary cholangiography had a positive predictive value of 92.6%(25/27)in predicting residual common bile duct stones.The univariate analysis showed that there were significant differences between the two groups in multiple stones,common bile duct diameter≥1.5 cm,and mechanical lithotripsy(χ²=5.014,7.651,and 9.670,all P<0.05).The multivariate logistic regression analysis showed that multiple stones(odds ratioOR]=2.713,95%confidence intervalCI]:1.002-7.345,P=0.049)and mechanical lithotripsy(OR=9.183,95%CI:2.347-35.925,P=0.001)were independent risk factors for residual stones.Conclusion Post-ERCP nasobiliary cholangiography is an effective method to detect residual common bile duct stones.Multiple stones and mechanical lithotripsy during ERCP are independent risk factors for residual stones.