胆总管结石经十二指肠乳头自行排石的预测因素分析

Predictive factors for spontaneous passage of common bile duct stones through the duodenal papilla

摘要:

目的 分析胆总管结石经十二指肠乳头自行排石的临床特征，探讨其自行排石的预测因素。方法 回顾性纳入2021年1月至2023年11月期间，在江苏省中医院门急诊或外院接受腹部影像学检查并诊断为胆总管结石的453例连续患者。根据患者是否发生胆总管自行排石的情况，将患者分为排石组和未排石组。采用多因素logistic回归分析筛选出胆总管结石患者自行排石的预测因素。结果 70例患者经证实为自发性排石，自发性排石率达15.5%。多因素logistic回归分析结果显示入院诊断为急性胆源性胰腺炎（OR=3.317，95%CI：1.427~7.713，P=0.005）、胆总管直径越宽（OR=1.117，95%CI：1.000~1.248，P=0.049）、胆总管单发结石（OR=11.135，95%CI：3.602~34.418，P<0.001）更容易出现自行排石，而胆总管结石长径越大（OR=0.539，95%CI：0.441~0.659，P<0.001）越不容易出现自行排石。针对胆总管直径和胆总管结石长径进行受试者工作特征（receiver operator characteristic，ROC）曲线分析显示，胆总管直径预测胆总管结石自发性排石的ROC曲线下面积为0.662，灵敏度和特异度分别为52.9%（37/70）和73.6%（51/70），cutoff值为9.5 mm；胆总管结石长径预测胆总管结石自发性排石的ROC曲线下面积为0.852，灵敏度和特异度分别为75.7%（53/70）和89.0%（62/70），cutoff值为4.5 mm。结论 胆总管单发小结石伴胆管扩张，入院诊断为急性胆源性胰腺炎是胆总管结石出现自发性排石的重要预测因素。胆总管直径≥9.5 mm，结石长径≤4.5 mm，更容易出现自发排石。

Abstract:

Objective To analyze the clinical characteristics and identify predictive factors for spontaneous passage of common bile duct (CBD) stones. Methods A retrospective analysis was conducted on patients diagnosed as having choledocholithiasis via abdominal imaging at outpatient and emergency departments of Jiangsu Province Hospital of Chinese Medicine and other medical institutions from January 2021 to November 2023. Participants were stratified into spontaneous passage versus non-passage groups. Multivariate logistic regression analysis was used to identify predictors for the spontaneous passage of common bile duct stones. Results Spontaneous stone passage were confirmed in 70 cases (15.5%). Multivariate logistic regression analysis identified that an admission diagnosis of acute biliary pancreatitis (OR=3.317, 95%CI: 1.427-7.713, P=0.005), larger common bile duct diameter (OR=1.117, 95%CI: 1.000-1.248, P=0.049), and solitary stones (OR=11.135, 95%CI: 3.602-34.418, P<0.001) significantly increased the probability of spontaneous stones. In contrast, larger stone long diameter (OR=0.539, 95%CI: 0.441-0.659, P<0.001) markedly decreased passage likelihood. Receiver operator characteristic (ROC) curve analysis demonstrated that the common bile duct diameter predicted spontaneous stone passage with an area under the curve (AUC) of 0.662, yielding sensitivity of 52.9% (37/70) and specificity of 73.6% (51/70) at a cutoff value of 9.5 mm. The common bile duct stone diameter achieved an AUC of 0.852 for predicting spontaneous stone passage, with sensitivity of 75.7% (53/70) and specificity of 89.0% (62/70) at a cutoff value of 4.5 mm. Conclusion Solitary small stones, ductal dilation, and an admission diagnosis of acute biliary pancreatitis are key predictive factors for spontaneous common bile duct stone passage. A common bile duct diameter ≥9.5 mm and stone long diameter ≤4.5 mm are more likely to result in spontaneous stone passage.