| Objective:To investigate the influential factors of Endoscopic Sphincterotomy combined with Endoscopic Papillary Balloon Dilatation on complications after endoscopic retrograde cholangiopancreatography,and to analyze and compare different balloon expansion diameters,different balloon expansion times,and different balloon expansion pressures on postoperative complications Influence.in order to find out the influencing factors of postoperative complications of ERCP,thereby reducing the incidence of postoperative complications.Methods:The clinical data of patients with common bile duct stones who underwent Endoscopic Sphincterotomy combined with Endoscopic Papillary Balloon Dilatation at the Second Affiliated Hospital of Kunming Medical University from January 2018 to July 2019 were retrospectively analyzed.Divided into 6mm group,8mm group,10mm group,12mm group,14mm group according to different balloon dilation diameter;Divided into 30s group,60s group,120s,>120s group according to different balloon expansion time;divided according to different balloon dilation pressures:2-3ATM group,3-4ATM group,4-5ATM group,≥5ATM group;compare the diameter,time,and pressure of postoperative complications of different balloon inflation;choose another set of data for further research on postoperative pancreatitis,combine balloon dilation diameters of 6mm,8mm,10mm into one group,and combine balloon dilation diameters of 12mm,14mm into one group Combine balloon dilation pressure of 2-3ATM and 3-4ATM into one group,combine balloon dilation pressure of 4-5ATM and greater than 5ATM into one group;balloon dilation time of 30s and 60s were combined into one group,and the balloon dilation time was 120s and greater than 120s were combined into one group.Postoperative pancreatitis in each group was analyzed.Results:1.General information:A total of 172 patients with different balloon diameters were collected and divided according to the diameter of the balloon:6mm group,a total of 32 patients;8mm group,a total of 41 patients;10mm group,a total of 37 patients;12mm group,a total of 24 cases,14 mm group,a total of 28 cases.There was no significant difference in gender,operation time,contrast dose,number of stones,duodenal papillary diverticulum,guide wire into pancreatic duct,and stone color in these five groups.There were differences in age and stone diameter between the five groups(P=0.003,P=0.00).A total of 124 patients with different balloon expansion times were collected and divided into:30s group,a total of 31 patients;60s group,a total of 38 patients;120s group,a total of 28 patients;greater than 120s group,a total of 28 patients;.There was no significant difference in gender,age,mechanical lithotripsy,contrast dose,stone diameter,number of stones,duodenal papillary diverticula,guide wire into the pancreatic duct,and stone color in these four groups.In terms of total operation time,the balloon dilatation time was 30s,the shortest operation time was 37.36±21.68min,and the longest operation time was balloon dilation time>120s group,49.11±19.32min,although the total operation time of the four groups was There was no statistically significant difference between the two groups,but the total balloon swell time of the 30s group was shorter than the 120s group and the 120s group.The results were statistically significant(P=0.036,0.033)A total of 144 patients with different balloon dilation pressures were collected and divided into:2-3ATM group,a total of 32 patients;3-4ATM group,a total of 42 patients;4-5 ATM group,a total of 37 patients;greater than 5ATM group,a total of 33 cases.There was no significant difference in gender,age,operation time,contrast dose,number of stones,stone diameter,duodenal papillary diverticulum,mechanical lithotripsy,guide wire into pancreatic duct,and stone color.2.Postoperative complications:postoperative bleeding,perforation,and hyperamylase have nothing to do with balloon dilatation diameter,time,and pressure;one postoperative perforation occurred in the group with a balloon diameter of 10 mm.Does the large balloon dilation increase?The probability of post-perforation still needs further study;postoperative biliary tract infections did not show statistical differences in different balloon dilation times and different balloon dilation pressure groups,but in patients with different balloon diameters,large balloon dilation(12 mm,14mm)patients had a higher probability of postoperative biliary tract infection than those who used small balloon dilatation(6mm,8mm,10mm),the difference was statistically significant(X2=5.417 P=0.02);postoperative pancreatitis was different The highest incidence of postoperative pancreatitis in the balloon dilatation diameter group was 12.20%for the balloon dilation diameter 8 mm group,and the lowest was 5.88%for the balloon dilation diameter 12 mm group.There was no statistically significant difference between the groups.The highest incidence of postoperative pancreatitis in the different balloon dilatation pressure groups was 9.09%for dilation pressure greater than the iso and 5ATM group,and the lowest was 2.38%for dilation pressure 3-4ATM group.There was no significant difference between the groups;different balloons The highest probability of postoperative pancreatitis in the dilated time group was 14.81%in the dilated time greater than 120s group,and the lowest was 2.63%in the dilated time 60s group.Although there was no statistical difference between the four dilated time groups,the dilated time There was a statistically significant difference between the 30s group and the 60s group compared with the 120s expansion group and the greater than 120s group(X2=4.392 P=0.036).3.Multifactor analysis of postoperative pancreatitis showed that the factors related to the occurrence of post-ERCP pancreatitis include balloon dilatation time,repeated guide wire entry into the pancreatic duct,and operation time.Gender,age,contrast dose,number of stones,stone diameter,duodenal papillary diverticulum,whether or not mechanical lithotripsy are independent of postoperative pancreatitis.Balloon dilatation time of 60 seconds or less is a protective factor for pancreatitis after ERCP.The OR and 95%confidence interval are(OR=0.298,95%CI:0.093～0.952,P=0.041),the operation time is too long and the guide wire Repeated entry into the pancreatic duct is a risk factor for pancreatitis after ERCP.The OR and 95%confidence intervals are(OR=6.600,95%CI:1.754～24.836,P=0.005)and(OR=3.778,95%CI:1.106～12.903,P=0.034).Conclusions:1.Endoscopic Sphincterotomy combined with Endoscopic Papillary Balloon Dilatation is a safe and effective stone removal method2.The diameter of common bile duct stones is related to the age of patients,and the large bile duct stones are more common in elderly patients,Endoscopic Sphincterotomy combined with Endoscopic Papillary Balloon Dilatation is a safe and effective method for ERCP lithotripsy in elderly patients.3.The larger the balloon dilatation diameter,the higher the probability of biliary infection after ERCP.The occurrence of bleeding,perforation,and hyperamylase after ERCP is not related to the balloon dilatation diameter,time,or pressure.4.Post-ERCP pancreatitis is related to balloon dilatation time,operation time,and intraoperative guidewire reentry into the pancreatic duct,and has nothing to do with balloon dilatation diameter and pressure;the optimal balloon dilation time is≤60s,the operation time is too long,and Repeated entry of the guide wire into the pancreatic duct can increase the probability of postoperative pancreatitis. |
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