老年患者ERCP术后胆总管结石复发的危险 因素分析及风险预测模型构建

Analysis of Risk Factors and Construction of Risk Prediction Model for Recurrence of Choledocholithiasis in Elderly Patients after ERCP

摘要: 目的：本研究旨在深入探讨老年患者行ERCP治疗后胆总管结石复发的危险因素，并基于独立危险因素构建临床风险预测模型，以期识别高危人群，为制定个体化的术后随访和干预策略提供科学依据。结果：多因素Logistic回归分析(LR向前法)最终确定胆囊手术史(OR = 5.220, 95%CI: 1.951~13.756)、胆总管直径 ≥ 1.5 cm (OR = 3.678, 95%CI: 1.455~9.365)、十二指肠乳头旁憩室(OR = 4.922, 95%CI: 1.954~12.379)为ERCP术后结石复发的独立危险因素。基于三者构建的联合预测模型的ROC曲线下面积(AUC)为0.814 (95%CI: 0.732~0.895)。结论：胆囊手术史、胆总管直径 ≥ 1.5 cm以及十二指肠乳头旁憩室是老年患者ERCP术后胆总管结石复发的独立危险因素。整合此三项指标构建的预测模型具有良好的判别能力，可用于识别术后复发高危患者，指导个体化随访与管理策略的制定。

Abstract: Objective: This study aimed to investigate the risk factors for choledocholithiasis recurrence in elderly patients following endoscopic retrograde cholangiopancreatography (ERCP), and to construct a clinical risk prediction model based on independent risk factors, with the goal of identifying high-risk populations and providing scientific evidence for individualized postoperative follow-up and intervention strategies. Results: Multivariate Logistic regression analysis (forward LR method) identified history of gallbladder surgery (OR = 5.220, 95%CI: 1.951~13.756), common bile duct diameter ≥1.5 cm (OR = 3.678, 95%CI: 1.455~9.365), and juxtapapillary duodenal diverticulum (OR = 4.922, 95%CI: 1.954~12.379) as independent risk factors for stone recurrence after ERCP. The combined prediction model constructed based on these three variables demonstrated an area under the ROC curve (AUC) of 0.814 (95%CI: 0.732~0.895). Conclusion: History of gallbladder surgery, common bile duct diameter ≥1.5 cm, and juxtapapillary duodenal diverticulum are independent risk factors for choledocholithiasis recurrence in elderly patients after ERCP. The prediction model integrating these three indicators exhibits good discriminative ability and can be used to identify high-risk patients for postoperative recurrence, guiding the formulation of individualized follow-up and management strategies.