内镜夹闭乳头成形术在预防内镜逆行胰胆管造影术后胆总管结石复发中的临床价值（含视频）

Clinical value of endoclip papillaplasty for preventing recurrent choledocholithiasis after endoscopic retrograde cholangiopancreatography (with video)

摘要:

目的 探讨内镜夹闭乳头成形术（endoclip papillaplasty，ECPP）在预防内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）后胆总管结石复发中的临床价值。方法 回顾性分析2019年1月至2023年12月在河南省人民医院接受ERCP治疗的1 941例胆总管结石患者资料，其中250例行ECPP者纳入ECPP组，以1∶1按年份分层抽样选取251例患者作为对照组。根据随访情况，最终ECPP组209例和对照组190例患者纳入分析。比较两组取石成功率、围手术期并发症发生率及术后胆总管结石复发率，并采用单因素和多因素logistic回归分析ERCP术后胆总管结石复发的影响因素。结果 两组取石成功率均为100.0%，ECPP组和对照组术中穿孔［0.5%（1/209）比1.1%（2/190），χ2=0.01， P=0.934］、术后高淀粉酶血症［21.5%（45/209）比17.4%（33/190），χ2=1.10，P=0.295］及ERCP术后胰腺炎［3.8%（8/209）比8.1%（9/190），χ2=0.20， P=0.653］发生率比较差异均无统计学意义。ECPP组出血率［5.1%（11/209）比12.3%（23/190），χ2=5.98，P =0.014］、胆总管结石复发率［10.5%（22/209）比18.9%（36/190），χ2=5.68，P=0.017］均低于对照组。多因素logistic回归分析显示，胆总管直径增加（OR=1.881，95%CI：1.101~3.213，P=0.021）是胆总管结石ERCP取石术后胆总管结石复发的危险因素。而女性（OR=0.482，95%CI：0.266~0.875，P=0.016）及ECPP（OR=0.497，95%CI：0.278~0.887，P=0.018）是ERCP取石术后胆总管结石复发的保护因素。结论 ECPP能有效降低ERCP术后胆总管结石复发率及出血风险。ECPP和女性是ERCP术后胆总管结石复发的保护因素，胆总管直径增加为危险因素。

Abstract:

Objective To evaluate the clinical efficacy of endoclip papillaplasty (ECPP) for preventing recurrent choledocholithiasis after endoscopic retrograde cholangiopancreatography (ERCP). Methods A retrospective analysis was conducted on 1 941 patients who underwent ERCP for choledocholithiasis in Henan Provincial People""s Hospital from January 2019 to December 2023. A total of 250 patients who received ECPP were assigned to the ECPP group, while 251 matched controls were selected via 1∶1 year-stratified sampling into the control group. After follow-up, 209 ECPP cases and 190 controls were ultimately included in the analysis. Stone removal success rate, incidence of perioperative complications, and postoperative choledocholithiasis recurrence were compared between the two groups. Univariate and multivariate logistic regression were used to determine the risk factors for choledocholithiasis recurrence after ERCP. Results Both groups achieved 100.0% stone removal success rate. There was no significant difference in the incidence of intraoperative perforation [0.5% (1/209) VS 1.1% (2/190), χ2=0.01, P=0.934], postoperative hyperamylasemia [21.5% (45/209) VS 17.4% (33/190), χ2=1.10, P=0.295] or post-ERCP pancreatitis [3.8% (8/209) VS 8.1% (9/190), χ2=0.20, P=0.653] between the ECPP group and the control group. The ECPP group showed significantly lower bleeding rate [5.1% (11/209) VS 12.3% (23/190), χ2=5.98, P=0.014] and choledocholithiasis recurrence rate [10.5% (22/209) VS 18.9% (36/190), χ2=5.68, P=0.017] compared with the control group. The multivariate logistic regression identified dilated common bile duct diameter (OR=1.881, 95%CI: 1.101-3.213, P=0.021) as an independent risk factor for choledocholithiasis recurrence, while being female (OR=0.482, 95%CI: 0.266-0.875, P=0.016) and ECPP (OR=0.497, 95%CI:0.278-0.887, P=0.018) were protective factors. Conclusion ECPP effectively reduces choledocholithiasis recurrence rate and bleeding risk after ERCP. ECPP and being female serve as protective factors for choledocholithiasis recurrence, while dilated bile duct diameter is an independent risk factor.