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胆总管结石内镜逆行胰胆管造影术后复发的临床预测模型:构建、验证及其临床应用价值研究

A clinical predictive model for recurrence after endoscopic retrograde cholangiopancreatography for choledocholithiasis: Construction, validation and study of its value for clinical application.

作者信息

Qiu Jinlun

机构信息

Department of Hepatobiliary Surgery, First People's Hospital of Huizhou, Huizhou City, Guangdong Province, China.

出版信息

Medicine (Baltimore). 2025 Sep 12;104(37):e44381. doi: 10.1097/MD.0000000000044381.

Abstract

Choledocholithiasis is a common biliary disorder whose treatment relies on endoscopic retrograde cholangiopancreatography (ERCP). Despite the remarkable clinical results of ERCP in the treatment of choledocholithiasis, postoperative recurrence remains a significant challenge. Therefore, accurate prediction of the risk of recurrence after ERCP is important for optimizing the treatment plan, reducing the recurrence rate and improving patient prognosis. To develop of a predictive model for choledocholithiasis recurrence after ERCP calculi removal procedure. A total of 415 patients were collected in this study. Recurrence occurred in 69 patients during the 1-year follow-up time after undergoing the ERCP calculi removal procedure, and 346 patients did not experience recurrence. Patient-related data were collected and past medical history was collected to study the correlates affecting calculus recurrence after ERCP calculi removal procedure in patients and to develop a predictive model. After analyzing the results, it was concluded that the number of calculuses, hyperlipidemia, angle of the common bile duct juncture, combined with intrahepatic bile duct calculuses, hypoproteinaemia, and the diameter of the common bile duct were risk factors for recurrence of choledocholithiasis after the ERCP calculi removal procedure, P < .2. The data obtained were further included in a multi-factor logistic regression analysis: the number of calculuses, hyperlipidemia, angle of the common bile duct juncture, combined with intrahepatic bile duct calculuses, hypoproteinaemia, and the diameter of the common bile duct, were independent risk factors for the recurrence of choledocholithiasis after ERCP removal procedure, P < .05. We have successfully established a clinical model with high predictive value, which can help clinicians to accurately assess the recurrence risk of patients before surgery, thus providing a scientific basis for personalized treatment.

摘要

胆总管结石是一种常见的胆道疾病,其治疗依赖于内镜逆行胰胆管造影术(ERCP)。尽管ERCP在治疗胆总管结石方面取得了显著的临床效果,但术后复发仍然是一个重大挑战。因此,准确预测ERCP术后的复发风险对于优化治疗方案、降低复发率和改善患者预后至关重要。为了建立ERCP取石术后胆总管结石复发的预测模型。本研究共收集了415例患者。69例患者在接受ERCP取石术后1年随访期间出现复发,346例患者未复发。收集患者相关数据和既往病史,以研究影响患者ERCP取石术后结石复发的相关因素,并建立预测模型。分析结果后得出结论,结石数量、高脂血症、胆总管汇合角、合并肝内胆管结石、低蛋白血症和胆总管直径是ERCP取石术后胆总管结石复发的危险因素,P < 0.2。将获得的数据进一步纳入多因素逻辑回归分析:结石数量、高脂血症、胆总管汇合角、合并肝内胆管结石、低蛋白血症和胆总管直径是ERCP取石术后胆总管结石复发的独立危险因素,P < 0.05。我们成功建立了一个具有高预测价值的临床模型,可帮助临床医生在术前准确评估患者的复发风险,从而为个性化治疗提供科学依据。

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