【摘要】 目的 探讨老年胆囊结石(GS)合并胆总管结石(CBDS)患者腹腔镜微创取石术后发生胰腺炎的危险因素及预测效能。方法 选择南阳市中心医院2020年1月至2023年1月收治的行腹腔镜微创取石术治疗的372例老年GS合并CBDS患者，根据术后是否发生胰腺炎分为胰腺炎组和非胰腺炎组。单因素和二元logistic回归分析老年GS合并CBDS患者腹腔镜微创取石术后并发胰腺炎的危险因素。结果 372例老年GS合并CBDS患者行腹腔镜微创取石术后胰腺炎发生率为13.71%。胰腺炎组乳头旁憩室、胰管显影、行胰管括约肌切开术、胰腺支架与鼻胆管引流患者占比分别为68.63%、76.47%、58.82%、45.10%,高于非胰腺炎组的33.33%、34.89%、19.31%、21.50%(P<0.05)。乳头旁憩室、胰管显影、胰腺支架与鼻胆管引流、行胰管括约肌切开术为老年GS合并CBDS患者腹腔镜微创取石术后并发胰腺炎的独立危险因素(P<0.05)。logistic回归模型对老年GS合并CBDS患者腹腔镜微创取石术后并发胰腺炎的曲线下面积为0.860(95%CI:0.792～0.933),敏感度为90.20%,特异度为67.29%。结论 老年GS合并CBDS患者腹腔镜微创取石术后并发胰腺炎风险较高，主要与乳头旁憩室、胰管显影、胰腺支架与鼻胆管引流、行胰管括约肌切开术等因素有关，基于上述因素构建预测模型具有良好预测效能，对上述危险因素进行针对性预防干预，可减少术后胰腺炎的发生，改善患者的预后。更多还原

【Abstract】 Objective To investigate the risk factors and predictive efficacy of pancreatitis after laparoscopic minimally invasive lithotomy in elderly patients with gallbladder stones(GS) and common bile duct stones(CBDS).Methods A total of 372 elderly patients with GS complicated with CBDS who underwent laparoscopic minimally invasive lithotomy in Nanyang Central Hospital from January 2020 to January 2023 were selected. They were divided into pancreatitis group and non pancreatitis group based on whether they developed pancreatitis after surgery. Univariate and binary logistic regression analysis were used to analyze the risk factors of pancreatitis after laparoscopic minimally invasive lithotomy in elderly patients with GS and CBDS.Results The incidence of pancreatitis after laparoscopic minimally invasive lithotomy in 372 elderly patients with GS and CBDS was 13.71%. The proportion of patients with peripapillary diverticulum, pancreatic duct visualization, pancreatic sphincterotomy, pancreatic stent and nasobiliary drainage in the pancreatitis group were 68.63%, 76.47%, 58.82%, and 45.10%, respectively, which were higher than those in the non pancreatitis group 33.33%, 34.89%, 19.31%, and 21.50%(P<0.05). Peripapillary diverticulum, pancreatic duct imaging, pancreatic stent and nasobiliary drainage and pancreatic sphincterotomy were independent risk factors for pancreatitis after laparoscopic minimally invasive lithotomy in elderly patients with GS and CBDS(P<0.05). The logistic regression model showed an area under the curve of 0.860(95% CI: 0.792-0.933) for pancreatitis after laparoscopic minimally invasive lithotomy in elderly patients with GS and CBDS, the sensitivity was 90.20%, and the specificity was 67.29%.Conclusion There is a higher risk of pancreatitis after laparoscopic minimally invasive lithotomyin elderly patientselderly patients with GS and CBDS, which is mainly related to parapillary diverticulum, pancreatic duct imaging, pancreatic stent and nasobiliary drainage and pancreatic duct sphincterotomy, etc. The prediction model built based on the above factors has good prediction efficacy. Targeted preventive interventions against the aforementioned risk factors can reduce the occurrence of postoperative pancreatitis and improve the prognosis of patients.更多还原