不同长度胰管支架对内镜逆行胰胆管造影术后胰腺炎发生率的影响分析

Influence of pancreatic duct stents of different lengths on the incidence of post‑endoscopic retrograde cholangiopancreatography pancreatitis

摘要:

目的 探索不同长度胰管支架对内镜逆行胰胆管造影术后胰腺炎（post‑endoscopic retrograde cholangiopancreatography pancreatitis， PEP）发生率的影响。方法 回顾性分析2013年1月至2022年1月期间在空军军医大学第一附属医院接受内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography， ERCP）且术中置入5 Fr预防性胰管支架的胆道疾病患者（n=299）资料，按使用支架的长度分为5 cm短支架组（n=163）与5 cm以上的长支架组（n=136），分别比较两组的基线资料、术中操作与术后情况，并采用倾向性评分匹配（propensity score matching， PSM）方法进行补充分析。主要研究终点为PEP发生率。采用logistic回归分析置入预防性胰管支架患者发生PEP的危险因素。结果 总体PEP发生率为11.0%（33/299）。短支架组和长支架组患者的PEP发生率［11.7% （19/163） 比 10.3% （14/136），χ2=0.140，P=0.708］，中-重症PEP发生率［1.8% （3/163） 比 2.2% （3/136），χ2=0.000，P=1.000］及2周内支架自发脱落率［81.7% （103/126） 比 78.4% （87/111），χ2=0.421，P=0.516］差异均无统计学意义。经PSM后，每组样本量为123例，总体PEP发生率为8.9% （22/246）。两组患者的PEP发生率［8.9% （11/123） 比 8.9% （11/123），χ2=0.000， P=1.000］，中-重症PEP发生率［0.8% （1/123）比1.6% （2/123），χ2=0.000， P=1.000］及2周内支架自发脱落率［80.6% （75/93）比78.6% （77/98）， χ2=0.126，P=0.722］差异均无统计学意义。logistic回归分析显示肝功能正常（OR=2.36，95%CI：1.01~5.51，P=0.046）与胆管插管失败（OR=7.51，95%CI：2.18~25.96，P=0.001）是胆道疾病患者预防性胰管支架置入后发生PEP的独立危险因素。结论 与5 Fr-5 cm胰管支架相比，长度更长的5 Fr胰管支架并不能进一步降低总体PEP和中-重症PEP风险。肝功能正常与胆管插管失败是胆道疾病患者预防性胰管支架置入术后发生PEP的独立危险因素。

Abstract:

Objective To explore the influence of pancreatic stents of different lengths on the incidence of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Methods Data of 299 patients with biliary tract diseases who received endoscopic retrograde cholangiopancreatography (ERCP) and 5 Fr prophylactic pancreatic stents placement at the First Affiliated Hospital of Air Force Medical University from January 2013 to January 2022 were retrospectively analyzed. Patients were divided into the short-stent group (<5 cm, n=163) and the long-stent group (>5 cm, n=136). Baseline data, intraoperative procedures, and postoperative outcomes were compared between the two groups and propensity score matching (PSM) was used for complementary analysis. The primary endpoint was the incidence of PEP. The risk factors for PEP in patients with prophylactic pancreatic stents placement was explored by logistic regression analysis . Results The overall PEP incidence was 11.0% (33/299). There was no significant difference in the PEP incidence [11.7% (19/163) VS 10.3% (14/136), χ2=0.140, P=0.708], moderate-to-severe PEP incidence [1.8% (3/163) VS 2.2% (3/136), χ2=0.000, P=1.000], or spontaneous stent dislodgement rate within two weeks [81.7% (103/126) VS 78.4% (87/111), χ2=0.421, P=0.516] between the two groups. After PSM, 123 patients were included in each group, and the overall PEP incidence was 8.9% (22/246). There was no significant difference in PEP incidence [8.9% (11/123) VS 8.9% (11/123), χ2=0.000, P=1.000], moderate-to-severe PEP incidence [0.8% (1/123) VS 1.6% (2/123), χ2=0.000, P=1.000], or spontaneous stent dislodgement rate within two weeks [80.6% (75/93) VS 78.6% (77/98), χ2=0.126, P=0.722] between the two groups. Logistic regression analysis showed that normal liver function (OR=2.36, 95%CI:1.01-5.51, P=0.046) and failed bile duct cannulation (OR=7.51, 95%CI:2.18-25.96, P=0.001) were independent risk factors for PEP in patients with biliary tract diseases who received prophylactic pancreatic stents placement. Conclusion Longer 5 Fr pancreatic stents (>5 cm) do not further reduce the overall risk of PEP or moderate-to-severe PEP compared with 5Fr-5 cm stent. Normal liver function and failure of bile duct intubation were independent risk factors for PEP after prophylactic pancreatic stent placement in patients with biliary diseases.