| Objective: To analyze the independent risk factors of PEP and PEHA after ERCP implantation of plastic stents for benign bile duct stenosis,and to establish a nomogram to predict the risk of PEP and PEHA after ERCP;Risk factors for recurrence of posterior stenosis.In order to identify high-risk patients for clinicians,timely personalized preventive measures can be taken to reduce the relative risk.Methods: The clinical data of 163 patients with benign bile duct stenosis who underwent ERCP implantation of plastic stents were collected from January 2016 to March 2020 in the Affiliated Hospital of Qing Hai University.PEP,PEHA and the risk factors of stenosis recurrence,Nomogram model was established to predict the risk according to the risk factors of PEP and PEHA,and the predictive value of the model was verified by ROC curve and enhanced Bootstrap method.Clinical decision curve(DCA)was used to verify the clinical benefit value of this model.Results: 1.PEP and PEHA are complications with higher incidence after ERCP.Female gender,EPBD,pancreatic duct imaging and higher WBC after ERCP are independent risk factors for BBS patients after stent placement through ERCP.High lymphocytes and preoperative indomethacin suppository(100mg)were protective factors.2.Established a risk prediction model for hyperamylaseemia and pancreatitis after implantation of plastic stents.The ROC curve of the model shows that the area under the curve is 0.936,95%CI(0.8947-0.9774),and the model correction C-index is 0.921 and 95%CI(0.8947-0.9774)by the bootstrap autonomous sampling method for 1000 repeated samplings,which means The nomogram has a certain guiding role for clinical practice.3.The risk factors of stenosis recurrence after ERCP implantation of plastic stents for benign bile duct stenosis are: the number of stents is less than 2(OR=1111.110,95%CI: 13.734-89888.192,P=0.002),the stenosis is located in the hepatic hilum(OR=349.889,95%CI: 5.913-20705.320,P<0.005)and bile duct angulation of 130 degrees(OR=49.431,95%CI: 1.513-1614.708,P=0.028)were independent risk factors for restenosis after plastic stent removal;Placement time(OR=0.722,95%CI: 0.594-0.879,P=0.001)was a protective factor for restenosis after removal of the plastic stent.Conclusions: 1.PEP and PEHA are complications with higher incidence after ERCP.Female gender,EPBD,pancreatic duct imaging and higher postoperative WBC may be independent risk factors for BBS patients after stent placement through ERCP.Higher lymphocytes and preoperative indomethacin suppository(100mg)may be its protective factors;2.Preliminarily established a risk prediction model for hyperamylaseemia and pancreatitis after implantation of plastic stents.The ROC curve of the model shows that the area under the curve is 0.936,95%CI(0.8947-0.9774),and the model correction Cindex is 0.921,95%CI(0.8947-0.9774),which means that the bootstrap autonomous sampling method performs 1000 repeated samplings to obtain a model correction Cindex of 0.921,which means The nomogram has a certain guiding role for clinical practice;3.The number of stents,hilar stenosis,and bile duct angle <130 degrees may be independent risk factors for the recurrence of BBS patients after stent placement through ERCP,and stent placement time may be the risk factor for BBS patients after stent placement through ERCP.protective factor. |
