| Objective: The definite risk factors and suspected risk factors related to PEP were statistically analyzed to explore the correlation between the suspected risk factors and PEP,so as to provide better applicability and safety for the clinical application of ERCP technology in patients with common bile duct stones,and also to provide a certain reference basis for the follow-up related research.Methods: Clinical data of 247 patients with common bile duct stones who underwent ERCP+EST+EPBD+ENBD in our hospital from January 2018 to December 2022 were retrospectively analyzed.According to the two classification criteria of common bile duct diameter and age,they were divided into dilated group(diameter of bile duct ≥10mm)(group A =84)and non-dilated group(diameter of bile duct < 10mm)(group B =163),and older group(age < 50 years)(group C =96)and older group(age ≥50 years)(group D =151).Observation group:(1)the basic information of patients including age,gender,common bile duct diameter,total hospitalization day;(2)Preoperative examination indicators: liver and kidney function,electrolytes,serum amylase,coagulation function,ultrasound,MRCP,CT and electrocardiogram results;(3)Intraoperative examination indicators: conditions of intubation(simple difficult intubation,insertion into the pancreatic duct,and visualization of the pancreatic duct),sphincter of oddi(whether there was suspected SOD),preventive measures of PEP(whether indomethacin was used or not);(4)Postoperative examination indicators: postoperative biochemical indicators,serum amylase,bile amylase,imaging review results,etc.(5)Postoperative clinical symptoms: abdominal pain,abdominal distension,vomiting,diarrhea and other digestive system symptoms.The above clinical datas were observed and classified before statistical processing.The patient characteristics,incidence of PEP and economic indicators of groups A,B,C and D were calculated.SPSS 26.0 statistical software was used to analyze the differences between groups A and B,C and D,and the risk factors related to PEP were analyzed by univariate and multivariate logistic regression analysis of the overall datas.Finally,the results were further analyzed,and the safety and operability of ERCP in patients with common bile duct stones under different circumstances were discussed,and how to avoid PEP as much as possible.Results: After strict inclusion and exclusion criteria,247 patients with simple common bile duct stones who underwent ERCP+EST+EPBD+ENBD were enrolled.Among these patients,10 patients were diagnosed as APBDJ,with an incidence of4.05%.There were 36 patients with PEP,and the incidence was 14.57%.There were 7patients with severe PEP,and the incidence was 2.83%.Three patients had a total hospitalization day of more than 100 days,and all of them had bile duct dilatation.Two of the three patients were diagnosed with APBDJ.The median diameter of common bile duct in 10 APBDJ patients was 1.15 cm.Nine patients were diagnosed with PEP and all had bile duct dilatation,and 8 of these 9 patients had uneven bile duct dilatation.In the general data of patients,the age,common bile duct diameter and median stone size of patients in group A were higher than those in group B,and the results were statistically significant.Among the risk factors related to PEP,the number of patients diagnosed with APBDJ and the number of patients with intraoperative pancreatic duct visualization in group A were higher than those in group B,and the results were statistically significant.In terms of PEP,the incidence of patients in group A was significantly higher than that in group B(25% vs 9.2%,P=0.001).In terms of economics,although there was no statistical significance between the two groups,the two indicators in group A were higher than those in group B and were comparable.In the general data of group C and D,the age,stone size and residual stone rate of group C were lower than those of group D,and the results were statistically significant.Among the related factors of PEP,the proportion of female patients and the number of APBDJ patients in group C were higher than those in group D,and the results were statistically significant.The incidence of PEP in group C was higher than that in group D,but the result was not statistically significant(P=0.064).In terms of economic indicators,the median length of hospital stay in group C was significantly shorter than that in group D(11d vs 14 d,P=0.002),and the results were statistically significant.logistic regression analysis of the case data of247 patients showed that in the univariate analysis,pancreatic duct visualization,simple difficult intubation,bile duct dilatation,female and APBDJ were significantly related to PEP and the results were statistically significant,while in the multivariate analysis of the above factors,only female(OR=3.843,P < 0.05).95%CI= 1.544～9.563,P=0.004)and APBDJ(OR=25.279,95%CI= 2.026～315.454,P=0.012)were independent risk factors for PEP.Conclusion: Female patients and patients with APBDJ are more likely to have PEP.Therefore,when performing endoscopic lithotomy for these patients,the indications should be strictly controlled and the intraoperative operation should be carefully handled,and the complex endoscopic operation should be avoided as far as possible.The hospitalization time of elderly patients after ERCP is significantly longer,so more careful,delicate and comprehensive postoperative management and nursing work should be carried out for these patients.There was no significant difference in the risk of PEP between patients with bile duct dilatation(diameter of bile duct ≥10mm)and patients without bile duct dilatation(diameter of bile duct <10mm).However,due to the close relationship between uneven bile duct dilatation and APBDJ,and considering the complexity and difficulty of clinical diagnosis of APBDJ,relevant examinations should be performed to identify the existence of APBDJ when treating patients with uneven bile duct dilatation,and endoscopic lithotomy should be performed according to the treatment of high-risk patients with PEP. |
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