Qian Maning,Wang Jiawei,Sun Song,et al.Analysis of tratment effects and prognostic factors impacting children of pancreaticobiliary maljunction without obvious biliary dilatation under therapeutic endoscopic retrograde cholangiopancreatography[J].Journal of Clinical Pediatric Surgery,2024,(01):16-21.[doi:10.3760/cma.j.cn101785-202308003-004]
十二指肠镜治疗儿童无明显胆管扩张型胰胆管合流异常的疗效及预后分析
- Title:
- Analysis of tratment effects and prognostic factors impacting children of pancreaticobiliary maljunction without obvious biliary dilatation under therapeutic endoscopic retrograde cholangiopancreatography
- 关键词:
- 胰胆管合流异常; 内窥镜逆行胰胆管造影术; 外科手术; 儿童
- Keywords:
- Pancreaticobiliary Maljunction; Endoscopic Retrograde Cholangiopancreatography; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨十二指肠镜治疗无明显胆管扩张型胰胆管合流异常(pancreaticobiliary maljunction without obvious biliary dilatation,PBM-nonOBD)患儿的手术疗效及预后不良相关因素。 方法 回顾性分析复旦大学附属儿科医院自2020年1月至2022年12月收治的内镜治疗PBM-nonOBD患儿的临床资料(包括人口学资料、临床症状、实验室检查及影像学资料),并对患儿进行随访。采用单因素分析及多因素Logistic回归分析十二指肠镜治疗PBM-nonOBD患儿不良预后的危险因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析相关危险因素的预测价值。 结果 本研究共纳入44例患儿,随访时间(19.7±8.6)个月,治愈率为54.5%(24/44),其中治疗有效24例(为治疗有效组),治疗无效20例(为治疗无效组)。术后不良事件以十二指肠镜逆行性胆胰管造影术后胰腺炎最常见(7/44,15.9%),其中27.3%(12/44)的患儿最终需接受根治术,15.9%(7/44)的患儿需接受再次内镜治疗。治疗有效组胰胆管合流异常(pancreaticobiliary maljunction,PBM)分型以B型和D型为主,占比分别为41.7%(10/24)和37.5%(9/24)。单因素分析结果显示,年龄偏小、胰胆共同管直径较长、胆总管最宽直径较宽是PBM-nonOBD患儿内镜手术后预后不良的相关因素(P＜0.05);多因素Logistic回归分析发现,年龄偏小(OR=1.645,95%CI:1.645~2.309)及胰胆共同管直径较长(OR=0.720,95%CI:0.720~0.968)是PBM-nonOBD患儿预后不良的独立危险因素(P＜0.05),曲线下面积(area under the ROC curve,AUC)分别为0.838(95%CI:0.719~0.958)和0.731(95%CI:0.567~0.894),最佳截断值分别为4.9岁和8.8 mm。 结论 十二指肠镜手术创伤小,不会导致严重并发症,可有效缓解部分PBM-nonOBD患儿症状;年龄偏小和胰胆共同管长度较长可能与十二指肠镜治疗PBM-nonOBD预后不良相关。
- Abstract:
- Objective To explore the efficacy and risk factors of poor outcomes in children of pancreaticobiliary maljunction without obvious biliary dilatation (PBM-nonOBD) after duodenoscopy.Methods From January 2020 to December 2022,retrospective analysis was conducted 1-on children with PBM-nonOBD treated by duodenoscopy in Children’s Hospital of Fudan University.They were assigned into two groups of effective (n=24) and ineffective (n=20) treatment.Demographic profiles,clinical symptoms,laboratory tests and imaging studies were collected and the children were followed up.Univariate and multivariate Logistic regression analyses were performed for identifying the risk factors influencing the outcomes after endoscopy.Receiver operating characteristic (ROC) curve was plotted for evaluate the predictive value of the relevant risk factors.Results During an average follow-up period of (19.7±8.6) months,the effective rate was 54.5%(24/44).Post-endoscopic retrograde cholangiopancreatography pancreatitis was the most common postoperative adverse event (7/44,15.9%).Ultimately radical surgery (27.3%) and repeat endoscopy (15.9%) were required.No significant inter-group differences existed in such preoperative laboratory parameters as serum amylase,transaminases or bilirubin.B/D-type PBM subtype predominated in effective treatment group,accounting for 41.7%(10/24) and 37.5%(9/24) respectively.Univariate analysis indicated that younger age,longer common channel length and greater maximal diameter of common bile duct (CBD) were significant factors associated with poor outcomes after endoscopy (P<0.05).Multivariable Logistic regression analysis revealed that younger age (OR=1.645,95%CI:1.645-2.309) and longer common channel length (OR=0.720,95%CI:0.720-0.968) were independent factors associated with poor outcomes (P<0.05).Area under the ROC curve (AUC) was 0.838(95%CI:0.719~0.958) and 0.731(95%CI:0.567~0.894) and optimal cutoff values were 4.9 years and 8.8 mm respectively.Conclusions With minimal surgical trauma and no serious complications,duodenoscopy can effectively relieve symptoms in children of PBM-nonOBD.Young age and longer common channel length may be associated with poor postoperative outcomes after duodenoscopy.
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备注/Memo
收稿日期:2023-8-1。
基金项目:国家自然科学基金面上项目(81873545); 上海市出生缺陷重点实验室开放基金项目(2022CSQX1005)
通讯作者:陈功,Email:chengongzlp@hotmail.com