Endoscopic sphincterotomy in the treatment of patients of choledocholithiasis combined with pancreatitis

doi:10.3877/cma.j.issn.1674-0793.2017.04.010

Abstract

Abstract:

Objective

To investigate the recurrence and survival of patients of choledocholithiasis combined with pancreatitis after endoscopic sphincterotomy (EST).

Methods

From January 2010 to December 2015, five hundred and sixty patients with choledocholithiasis and pancreatitis in Yulin First Hospital of Shanxi underwent EST treatment. According to the recurrence of pancreatitis, the patients were divided into two groups: recurrent pancreatitis group (180 cases) and non-recurrent pancreatitis group (380 cases). Depending on the patients’ pancreatitis condition, the gallbladder was removed after EST operation. Univariate and multivariate survival analysis were performed using Kaplan-Meier and Cox proportional hazards regression model to determine the risk factors of cumulative recurrence rate in patients with pancreatitis. Log-Rank test was used to compared the difference of the cumulative recurrence rate.

Results

All the patients received EST, with 410 (73.2%) cases of hyperamylasemia, 126 (22.5%) recurrence of pancreatitis, 36 (6.4%) recurrence of moderate acute pancreatitis and 18 (3.2%) severe pancreatitis. Mild, moderate and severe pancreatitis accounted for 70.0%, 20.0% and 10.0% respectively of the total number of patients with recurrent pancreatitis. Young age, pancreatic duct opacification, cholecystectomy, long operation time, jaundice, higher CCI score, cerebral vascular disease, diabetes, hypertension, chronic liver disease, and obesity were the risk factors of recurrence of postoperative pancreatitis patients received EST (P<0.05). In addition, cumulative recurrence rate and mortality rate were lower in patients with cholecystectomy (P<0.05).

Conclusion

Cholecystectomy can reduce the recurrence rate and mortality of pancreatitis in patients with pancreatitis after EST, and it should be popularized and applied in clinic.

Key words: Sphincterotomy, endoscopic, Cholecystectomy, Pancreatitis, Recurrence, Cumulative survival rate

Furong Li, Fuyong Niu, Hua Li. Endoscopic sphincterotomy in the treatment of patients of choledocholithiasis combined with pancreatitis[J]. Chinese Archives of General Surgery(Electronic Edition), 2017, 11(04): 255-259.

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Figures/Tables 5

References 18

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组别	例数	术前	术后12 h	术后24 h	术后48 h	术后72 h
胰腺炎复发组	180	361.23±25.26	320.56±26.58	285.26±52.15	255.33±41.91	205.21±43.62
胰腺炎未复发组	380	360.59±26.52	324.63±30.21	280.53±42.82	248.62±35.62	200.13±54.34
t值		-0.29	0.52	-0.42	-0.63	-1.19
P值		0.77	0.51	0.62	0.44	0.24

组别	例数	术前	术后12 h	术后24 h	术后48 h	术后72 h
胰腺炎复发组	180	361.23±25.26	320.56±26.58	285.26±52.15	255.33±41.91	205.21±43.62
胰腺炎未复发组	380	360.59±26.52	324.63±30.21	280.53±42.82	248.62±35.62	200.13±54.34
t值		-0.29	0.52	-0.42	-0.63	-1.19
P值		0.77	0.51	0.62	0.44	0.24

因素		胰腺炎复发组	胰腺炎未复发组	χ²值	P值
例数		180	380
性别（男/女）				1.71	0.19
	男	120	230
	女	60	150
年龄（岁）				14.56	<0.01
	<60	81	120
	60~70	59	155
	>70	40	105
术中静脉麻醉				1.48	0.22
	有	58	102
	无	122	278
胰管显影				20.94	<0.01
	有	102	136
	无	78	244
胆囊切除术				85.38	<0.01
	有	45	255
	无	135	125
手术时间（min）				15.36	<0.01
	<30	33	255
	30~<60	66	70
	≥60	81	55
胆管扩张				0.78	0.38
	有	105	205
	无	75	175
黄疸				18.27	<0.01
	有	123	185
	无	57	195
冠状动脉疾病
	有	80	170
	无	100	210
脑血管病				65.56	<0.01
	有	140	155
	无	40	225
糖尿病				60.27	<0.01
	有	135	150
	无	45	230
高血压				112.99	<0.01
	有	144	120
	无	36	260
慢性肝病				36.93	<0.01
	有	126	160
	无	54	220
慢性肾病				0.05	0.82
	有	85	185
	无	95	195
肥胖症状				48.18	<0.01
	是	120	133
	否	60	247

因素		胰腺炎复发组	胰腺炎未复发组	χ²值	P值
例数		180	380
性别（男/女）				1.71	0.19
	男	120	230
	女	60	150
年龄（岁）				14.56	<0.01
	<60	81	120
	60~70	59	155
	>70	40	105
术中静脉麻醉				1.48	0.22
	有	58	102
	无	122	278
胰管显影				20.94	<0.01
	有	102	136
	无	78	244
胆囊切除术				85.38	<0.01
	有	45	255
	无	135	125
手术时间（min）				15.36	<0.01
	<30	33	255
	30~<60	66	70
	≥60	81	55
胆管扩张				0.78	0.38
	有	105	205
	无	75	175
黄疸				18.27	<0.01
	有	123	185
	无	57	195
冠状动脉疾病
	有	80	170
	无	100	210
脑血管病				65.56	<0.01
	有	140	155
	无	40	225
糖尿病				60.27	<0.01
	有	135	150
	无	45	230
高血压				112.99	<0.01
	有	144	120
	无	36	260
慢性肝病				36.93	<0.01
	有	126	160
	无	54	220
慢性肾病				0.05	0.82
	有	85	185
	无	95	195
肥胖症状				48.18	<0.01
	是	120	133
	否	60	247

因素	β值	SE	Wald值	OR	95% CI	P值
年龄	0.152	0.120	8.350	0.204	0.104~0.585	<0.01
胰管显影	0.194	0.005	6.552	3.115	1.764~10.377	0.01
胆囊切除术	0.203	0.146	8.021	2.125	1.281~5.334	<0.01
CCI评分	0.165	0.410	7.385	1.264	1.084~2.202	<0.01
高血压	0.211	0.001	4.585	2.016	1.269~5.633	0.02
肥胖	0.152	0.402	7.390	0.212	0.103~0.567	<0.01

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