Risk of renal stone events in primary hyperparathyroidism before and after parathyroid surgery: controlled retrospective follow up study

AimTo study the risk of renal stone episodes and risk factors for renal stones in primary hyperparathyroidism before and after surgery.DesignRegister based, controlled retrospective follow up study.SettingTertiary hospitals in Denmark.Participants674 consecutive patients with surgically verified primary hyperparathyroidism. Each patient was compared with three age- and sex-matched controls randomly drawn from the background population. Hospital admissions for renal stone disease were compared between patients and controls. Risk factors for renal stones among patients were assessed.ResultsRelative risk of a stone episode was 40 (95% confidence interval 31 to 53) before surgery and 16 (12 to 23) after surgery. Risk was increased 10 years before surgery, and became normal more than 10 years after surgery. Stone-free survival 20 years after surgery was 90.4% in patients and 98.7% in controls (risk difference 8.3%, 4.8% to 11.7%). Patients with preoperative stones had 27 times the risk of postoperative stone incidents than controls. Before surgery, males had more stone episodes than females and younger patients had more stone episodes than older patients. Neither parathyroid pathology, weight of removed tissue, plasma calcium levels, nor skeletal pathology (fractures) influenced the risk of renal stones. After surgery, younger age, preoperative stones and ureteral strictures were significant risk factors for stones.ConclusionsThe risk of renal stones is increased in primary hyperparathyroidism and decreases after surgery. The risk profile is normal 10 years after surgery. Preoperative stone events increase the risk of postoperative stones. Stone formers and non-stone formers had the same risk of skeletal complications.

What is already known on this topic

Patients with primary hyperparathyroidism have an increased risk of renal stone eventsThe extent to which parathyroid surgery reduces the risk of further stones is unclear

What this study adds

The risk of a new stone event was 8.3% higher in patients than in controls after surgeryIn patients with stone disease before operation the risk rate for a postoperative stone event was 27times that in controlsThe risk of a renal stone event was higher than the risk among controls until more than 10 years after surgery     

Hook of hamate fractures: critical evaluation of different therapeutic procedures

The treatment of choice in nondisplaced hook of hamate fractures is conservative, with lower arm splinting. Displaced fractures should be treated operatively, whereby excision of the fragment or open reduction and internal fixation are described. A hamulus ossis hamati fracture was verified in 14 patients (mean age, 42 years; range, 21 to 73 years) including 11 men and three women. In six patients (42.9 percent), conservative treatment was initiated immediately after trauma with a lower arm cast for 6 weeks, and eight patients (57.1 percent) were operated on primarily. In five patients (35.7 percent), the fragment was excised, and in three patients (21.4 percent), an open reduction and internal fixation was performed using a screw. In five of six patients treated conservatively, nonunion of the fracture with persisting clinical symptoms developed. All of those patients were treated operatively, whereby three patients underwent excision and two patients underwent screw fixation, which led to elimination of the symptoms. One patient was asymptomatic despite nonunion of the fracture and rejected surgery. All of the eight patients operated on primarily were asymptomatic 3 months after surgery. Therefore, the success rate of primary surgical treatment (eight of eight) was significantly higher compared with conservative treatment(one of six). Finally, all 14 patients were asymptomatic at late postoperative follow-up. The clinical outcome of patients with hook of hamate fractures treated conservatively was disappointing. Therefore, primary surgical treatment is recommended. In our patients, excision and open reduction and internal fixation led to comparable results.     

Association of Parathyroidectomy With 5-Year Clinically Significant Kidney Stone Events in Patients With Primary Hyperparathyroidism

ObjectivePatients with primary hyperparathyroidism (PHPT) are at increased risk of kidney stones. Guidelines recommend parathyroidectomy in patients with PHPT with a history of stone disease. This study aimed to compare the 5-year incidence of clinically significant kidney stone events in patients with PHPT treated with parathyroidectomy versus nonoperative management.MethodsWe performed a longitudinal cohort study of patients with PHPT in a national commercial insurance claims database (2006-2019). Propensity score inverse probability weighting-adjusted multivariable regression models were calculated.ResultsWe identified 7623 patients aged ≥35 years old with continuous enrollment >1 year before and >5 years after PHPT diagnosis. A total of 2933 patients (38.5%) were treated with parathyroidectomy. The cohort had a mean age of 66.5 years, 5953 (78.1%) were female, and 5520 (72.4%) were White. Over 5 years, the unadjusted incidence of ≥1 kidney stone event was higher in patients who were managed with parathyroidectomy compared with those who were managed nonoperatively overall (5.4% vs 4.1%, respectively) and among those with a history of kidney stones at PHPT diagnosis (17.9% vs 16.4%, respectively). On multivariable analysis, parathyroidectomy was associated with no statistically significant difference in the odds of a 5-year kidney stone event among patients with a history of kidney stones (odds ratio, 1.03; 95% CI, 0.71-1.50) or those without a history of kidney stones (odds ratio, 1.16; 95% CI, 0.84-1.60).ConclusionBased on this claim analysis, there was no difference in the odds of 5-year kidney stone events in patients with PHPT who were treated with parathyroidectomy versus nonoperative management. Time horizon for benefit should be considered when making treatment decisions for PHPT based on the risk of kidney stone events.     

Systematic review of role of bisphosphonates on skeletal morbidity in metastatic cancer

Objective To review the evidence for the use of bisphosphonates to reduce skeletal morbidity in cancer patients with bone metastases.Data sources Electronic databases, scanning reference lists, and consultation with experts and pharmaceutical companies. Foreign language papers were included.Study selection Included trials were randomised controlled trials of patients with malignant disease and bone metastases who were treated with oral or intravenous bisphosphonate compared with another bisphosphonate, placebo, or standard care. All trials measured at least one outcome of skeletal morbidity.Results 95 articles were identified; 30 studies fulfilled inclusion criteria. In studies that lasted ≥ 6 months, compared with placebo bisphosphonates significantly reduced the odds ratio for fractures (vertebral 0.69, 95% confidence interval 0.57 to 0.84, P < 0.0001; non-vertebral 0.65, 0.54 to 0.79, P < 0.0001; combined 0.65, 0.55 to 0.78, P < 0.0001), radiotherapy (0.67, 0.57 to 0.79, P < 0.0001), and hypercalcaemia (0.54, 0.36 to 0.81, P = 0.003) but not for orthopaedic surgery (0.70, 0.46 to 1.05, P = 0.086) or spinal cord compression (0.71, 0.47 to 1.08, P = 0.113). The reduction in orthopaedic surgery was significant in studies that lasted over a year (0.59, 0.39 to 0.88, P = 0.009). Use of bisphosphonates significantly increased time to first skeletal related event but did not increase survival. Subanalyses showed that most evidence supports use of intravenous aminobisphosphonates.Conclusions In people with metastatic bone disease bisphosphonates significantly decrease skeletal morbidity, except for spinal cord compression and increased time to first skeletal related event. Treatment should start when bone metastases are diagnosed and continue until it is no longer clinically relevant.     

Prediction of gall-stone pancreatitis by computer.

The clinical features at presentation of 53 patients admitted with primary acute pancreatitis due to gall stones were compared with those of 31 patients in whom the disease was due to other causes. Between these two groups 10 significant differences existed. By listing the frequency of symptoms and signs for each group a computer data base was prepared and incorporated into a program used in the differential diagnosis of acute abdominal pain. A program written to predict the presence of gall stones in patients with acute pancreatitis was accurate in 92% of the patients studied. A predictive index devised from the presence of three of the significantly differing clinical features correctly identified 82% of patients with gall-stone pancreatitis. Predicting the presence of gall stones on admission by analysing the presenting symptoms and signs with a computer had an accuracy comparable to that of ultrasonography or radiology and may be of value in the management of patients with acute pancreatitis.     

Functional status of hip joint after surgical and conservative treatment of acetabular fracture

Both conservative and surgical treatment of acetabular fractures alter biomechanical conditions in the hip joint resulting in various degenerative changes in the acetabulum and the femur head. These changes may progress to secondary coxarthrosis, causing dysfunction of the hip joint. The aim of this paper is to compare the outcomes of both conservative and surgical treatments in different types of acetabular fractures, so that clear indications for either conservative or surgical treatment could be determined. This paper is based on retrospective study of 103 patients with acetabular fracture (21 surgically treated and 82 conservatively treated). In this study the incidence of particular types of acetabulum fractures, the treatment period, the incidence of complications and the functional status of the hip after the treatment were analyzed. In patients with anterior fracture surgical treatment lasted three times less than conservative treatment and resulted in far better functional status of the hip joint compared to conservatively treated patients. However, in patients with transverse fractures the functional status was better and the treatment period shorter after the conservative treatment. We believe that the present treatment indications should be corrected so that in anterior column fracture the surgical method should be preferred, whereas the transverse fracture should be treated conservatively. In other types of acetabular fracture, with the radiographic roof arc angle of 45 degrees or less, the surgical method should be preferred to conservative method.     

草酸钙肾结石成因的研究现状

肾结石是一种全球性疾病,同时也是泌尿外科最常见的疾病之一。近年来,肾结石在我国的发病率有逐渐上升趋势,大约5%-15%的人群一生中会罹患肾结石,其中约80%为草酸钙肾结石。多数草酸钙肾结石患者没有发现伴有其他系统疾病的存在,称为特发性草酸钙肾结石;一些患者存在原发性甲状旁腺功能亢进或其他钙代谢异常性疾病;一些患者主要表现为高草酸尿症等。虽然近年来体外冲击波碎石和内腔镜技术的发展使本病的治疗取得了很大的进展,然而,肾结石的复发率仍居高不下,10年复发率可达50%,20年的复发率可达75%。因此,如何有效地预防结石发生和降低复发率,成为当前研究的重点内容。这对于制定恰当的、个性化的预防方案有重要价值。     

Comparison of results for operative and conservative treatment of multisegmental atheromatous arterial occlusion in the lower limbs after a 2-year period of observation]

Two hundred eighty seven patients treated surgically and 139 patients treated conservatively for multisegmental arterial occlusion in the lower limbs were followed up for two years. The results of therapy have been compared according to the site of arterial occlusion and the degree of ischemia. Surgery produces more chances for favourable results but an amputation rate or deaths are more frequent, than in case of the conservative treatment. No expected relationship between the results of surgery and of conservative therapy, localization and extension of the atheromatous process has been shown after a 2-year follow up.     

小切开EST联合EPBD与单纯EST对85岁以上老年胆总管结石患者疗效的比较

目的:对比内镜下十二指肠乳头括约肌(expressed sequence tags,EST)小切开术联合内镜下十二指肠乳头括约肌扩张术(endoscopic papillary balloon dilation,EPBD)与单纯EST对85岁以上老年胆总管结石患者的疗效。方法:选择我院于2014年1月～2020年2月收治的85岁以上老年胆总管结石患者150例,根据入院顺序随机分成两组,每组各75例,给予对照组单纯小切开EST术治疗,给予研究组小切开EST+EPBD术治疗。对比两组的一次取石成功率、机械碎石、结石复发率等指标;术中操作时间、术中出血量、住院天数、术后排便天数等临床指标;术后胆道感染、急性胰腺炎、高淀粉酶血症、术后腹痛等并发症的总发生率。结果:研究组一次取石成功率显著高于对照组,机械碎石、结石复发率均显著低于对照组(P0.05);研究组的术中操作时间、术中出血量、住院天数、术后排便天数均显著低于对照组(P0.05);研究组术后胆道感染、急性胰腺炎、高淀粉酶血症、术后腹痛、术后迟发性出血等并发症的总发生率为9.33%(7/75),显著低于对照组37.33%(28/75),差异具有统计学意义(P0.05)。结论:小切开EST联合EPBD对85岁以上老年胆总管结石患者的疗效显著,该方法可有改善患者临床指标,降低术后并发症发生率,值得推荐至临床广泛应用。     

Surgical Treatment of Necrotizing Pancreatitis

Surgical treatment in patients with severe acute pancreatitis is still a controversial subject, ranging from sole conservative to an aggressive approach. This article gives an overview of the literature with regard to indications for surgery, timing and techniques of operative treatment concepts in severe acute pancreatitis with special attention to the recommended necrosectomy and closed continuous lavage of the involved retroperitoneum. Taking into account recent findings from microbiological data we have developed a new algorithm in patients with acute pancreatitis. All patients with proven acute necrotizing pancreatitis receive an antibiotic therapy for 2 weeks beside the intensive care measures. So far only one third (33 percent) had infected pancreatic necroses in the 3rd week of the onset of the disease and were managed surgically. The delay resulted in optimal surgical conditions for necrosectomy and a mortality rate of 9 percent. This new concept and therapeutic approach with the early suitable antibiotic therapy in patients with proven necrotizing pancreatitis is recommended to (1) decrease the infection rate and (2) delay surgical intervention to the 3rd week of the disease with optimal surgical conditions. It seems that only patients with proven infected pancreatic necroses are candidates for surgical intervention.     

The renal sensitivity for endogenous parathormone in patients with primary hyperparathyroidism, vitamin D deficiency and renal stones

Baseline levels and increases in urinary cyclic AMP excretion (UcAMP) and immunoreactive parathormone (iPTH) were studied before and during infusion of EDTA in euparathyroid patients with renal stones (n=11), patients with primary hyperparathyroidism (PHP; n=14) and patients with vitamin D deficiency (n = 12). In all three groups, EDTA evoked a significant rise in iPTH and UcAMP. In patients with PHP and in those with vitamin D deficiency, there was a sufficiently close relationship between increments in iPTH (delta iPTH) and in UcAMP (delta UcAMP) (r = 0.90, P less than 0.001 and r = 0.67, P less than 0.02, respectively) to use this model to assess renal sensitivity for changes to endogenous PTH levels. We quantified sensitivity of the kidney for PTH, by calculating the ratio delta UcAMP/delta TPTH for the three studied groups. The ratio was comparable in patients with renal stones (16.7 +/- 10.3) and PHP (13.8 +/- 4.9, P greater than 0.10), but was significantly increased in patients with vitamin D deficiency (33.2 +/- 17.9; P less than 0.01 versus patients with renal stones and P less than 0.01 versus patients with PHP). Within the group of patients with PHP there was no correlation between baseline serum calcium concentrations and the ratio delta UcAMP/delta TPTH. It is concluded that in patients with vitamin D deficiency, renal sensitivity to PTH is increased compared with patients with PHP and euparathyroid patients with renal stones, perhaps an expression of a teleological useful adaptation of end organ sensitivity.     

A case report: Giant cystic parathyroid adenoma presenting with parathyroid crisis after Vitamin D replacement

ABSTRACT: BACKGROUND: Parathyroid adenoma with cystic degeneration is a rare cause of primary hyperparathyroidism. The clinical and biochemical presentation may mimic parathyroid carcinoma. Case Presentation: We report the case of a 55 year old lady, who had longstanding history of depression and acid peptic disease. Serum calcium eight months prior to presentation was slightly high, but she was never worked up. She was found to be Vitamin D deficient while being investigated for generalized body aches. A month after she was replaced with Vitamin D, she presented to us with parathyroid crisis. Her corrected serum calcium was 23.0 mg/dL. She had severe gastrointestinal symptoms and acute kidney injury. She had unexplained consistent hypokalemia until surgery. Neck ultrasound and CT scan revealed giant parathyroid cyst extending into the mediastinum. After initial medical management for parathyroid crisis, parathyroid cystic adenoma was surgically excised. Her serum calcium, intact parathyroid hormone, creatinine and potassium levels normalized after surgery. CONCLUSION: This case of parathyroid crisis, with very high serum calcium and parathyroid hormone levels, is a rare presentation of parathyroid adenoma with cystic degeneration. This case also highlights that Vitamin D replacement may unmask subclinical hyperparathyroidism. Consistent hypokalemia until surgery merits research into its association with hypercalcemia.     

Bone fracture in elderly female with primary hyperparathyroidism: relationship among renal function, vitamin D status and fracture risk

Among 12 aged postmenopausal females with primary hyperparathyroidism, 5 had no bone fracture and 7 had fractures. Both serum 1,25 (OH)2D levels and creatinine clearance values in patients with fracture were significantly lower than those without fracture (p less than 0.025). In addition, significant positive correlation was observed between serum 1,25 (OH)2D levels and creatinine clearance values (p less than 0.05). These data suggest that decreased serum 1,25 (OH)2D level due to renal dysfunction may causally correlate to bone fracture in postmenopausal primary hyperparathyroidism.     

Renal Calculi

The pathogenesis of renal calculi is reviewed in general terms followed by the results of investigation of 439 patients with renal calculi studied by the author at Toronto General Hospital over a 13-year period. Abnormalities of probable pathogenetic significance were encountered in 76% of patients. Idiopathic hypercalciuria was encountered in 42% of patients, primary hyperparathyroidism in 11%, urinary infection in 8% and miscellaneous disorders in 8%. The incidence of uric acid stones and cystinuria was 5% and 2% respectively. In the remaining 24% of patients in whom no definite abnormalities were encountered the mean urinary magnesium excretion was less than normal. Of 180 patients with idiopathic hypercalciuria, only 24 were females. In the diagnosis of hyperparathyroidism, the importance of detecting minimal degrees of hypercalcemia is stressed; attention is also drawn to the new observation that the upper limit of normal for serum calcium is slightly lower in females than in males. The efficacy of various measures advocated for the prevention of renal calculi is also reviewed. In the author''s experience the administration of thiazides has been particularly effective in the prevention of calcium stones. Thiazides cause a sustained reduction in urinary calcium excretion and increase in urinary magnesium excretion. These agents also appear to affect the skeleton by diminishing bone resorption and slowing down bone turnover.     

Significance of parathyroid hormone (PTH) radioimmunoassay in the diagnosis of primary hyperparathyroidism: an experience based on 63 surgically proven cases

The significance of PTH-radioimmunoassay was assessed in 63 surgically proven cases of primary hyperparathyroidism. To detect hyperparathyroidism, an increase in the free serum Ca index, [1-(8 X Alb + 2 X Glb + 3)/100] X Ca, has the highest predictive value (100%) for a positive test but a low predictive value (11.8%) for a negative test. It was necessary to improve the criteria to rule out the diagnosis of hyperparathyroidism. We therefore carried out a PTH radioimmunoassay employing kits made by CIS. The criteria for ruling out the diagnosis of hyperparathyroidism were that free serum Ca index was lower than 3 and PTH was lower than 4 mU/ml. The predictive value of these criteria for ruling out the diagnosis was 83.3%, significantly greater than the previously described criteria. Furthermore, the PTH concentration was significantly correlated to the weight of pathological parathyroid tissue surgically excised and to the free serum Ca index, although to a lesser extent than the latter. Thus, PTH-RIA is of value in improving diagnostic accuracy and in determining the severity of the disease.     

乌司他丁治疗不同类型急性胰腺炎的临床疗效

目的:探讨乌司他丁用于治疗不同类型急性胰腺炎的临床疗效和安全性。方法:收集2013年1月至2014年1月我院收治的急性胰腺炎患者84例,随机分为观察组与对照组,每组各42例,两组患者均给予常规治疗,对照组加用奥曲肽治疗,观察组在对照组的基础上加用乌司他丁治疗,观察和比较两组患者的临床疗效、治疗前后血清IL-6和TNF-α水平的变化及不良反应的发生情况。结果:观察组的总有效率为96.72%,显著高于对照组的85.71%;其中,两组急性水肿型胰腺炎的疗效相当(P0.05),但观察组出血坏死型胰腺炎的有效率显著高于对照组(P0.05)。治疗后,两组血清IL-6与TNF-α水平均较治疗前显著降低,并且观察组显著低于对照组(P0.05),水肿型胰腺炎患者血清IL-6及TNF-α水平显著低于出血坏死型胰腺炎患者,差异均具有统计学意义(P0.05)。两组均未发生肝肾功能损害,未见药物相关性不良反应。结论:乌司他丁用于辅助治疗急性胰腺炎能够明显下调炎症因子水平,临床疗效显著,对急性水肿型胰腺炎的疗效尤为显著,安全性好,值得推广应用。     

The causes and consequences of maxillofacial injuries in elderly people

Objective: The occurrence of trauma in older people is well‐documented; however the incidence of maxillofacial trauma is scarcely reported. Therefore, the objective of this study is to determine the causes and consequences of maxillofacial trauma in older people. Design: A five‐year (March 95 ‐ March 2000) retrospective study was earned out of all patients over the age of 65 years with facial trauma presenting to Accident and Emergency Department (A&E). The information was collected using the medical notes and discharge summaries. Setting: The Departments of A&E and Maxillofacial Surgery. Subjects: A total of 42 patients' records were examined for study related data. Results: A total of 42 patients were seen during the study period. Thirty‐six gave a history of a fall, of which 15 had tripped, 5 had slipped, 3 resulted from a Transient Ischaemic Attack (TIA), 1 as a result of alcohol abuse, in 1 a prosthetic knee gave way and 11 gave no cause for the fall. Of the remaining 6 patients. 5 were assaulted and 1 had a wardrobe fall on top of him. The majority of the falls occurred during the winter months. Maxillofacial injuries were noted in 27 of the 42 patients. Sixteen patients had cheekbone fractures, 8 mandibular fractures, 2 midface and 1 orbital complex fracture. Twenty‐five percent of cheekbone fractures and 50% of mandibular fractures were treated surgically. Medical history was noted in 27 patients. Conclusions: This study clearly demonstrates the majority of the facial trauma in the older people can be treated conservatively unless the patients complain of functional problems.     

Prospective randomised study of preoperative endoscopic sphincterotomy versus surgery alone for common bile duct stones.

One hundred and twenty patients with known common bile duct stones were entered into a prospective randomised study of preoperative endoscopic sphincterotomy and stone clearance (group 1) versus surgery alone (group 2). Five patients were incorrectly entered; the 55 patients randomised to group 1 and the 60 randomised to group 2 were well matched with respect to clinical features and biochemical and medical risk factors. In group 1 endoscopic stone clearance was successful in 50 patients (91%); five of these patients refused elective surgery, though this was subsequently necessary in one. In group 2 common bile duct stones were cleared surgically in 54 of 59 patients (91.5%); one patient was treated by endoscopic sphincterotomy alone because of a myocardial infarct. The overall major complication rate in group 1 was 16.4% and included two deaths; in group 2 this was 8.5% and included one death. The minor complication rate in group 1 was 16.4% and that in group 2 13.6%. These differences in outcome were not significant. Despite a significant reduction in total hospital stay of patients in group 1, these results do not support the routine use of preoperative endoscopic sphincterotomy in patients having biliary surgery for stones in the common bile duct.     

经内镜逆行胰胆管造影术后急性胰腺炎患者的血浆白蛋白水平的变化与预后的相关性

摘要 目的：探讨经内镜逆行胰胆管造影术前后急性胰腺炎患者的血浆白蛋白水平的变化与预后的相关性。方法：2015年8月到2019年1月选择在本院诊治的急性胰腺炎患者68例,根据治疗方法的不同分为经内镜逆行胰胆管造影(encoscopic retrograde cholangio pancreatography,ERCP)组和保守治疗组,同期选择在本院进行体检的非胰腺炎患者34例作为对照组。ERCP组患者都给予经内镜逆行胰胆管造影手术治疗,保守治疗组给予内科保守治疗。记录血浆白蛋白水平变化情况,及预后并进行相关性分析。结果：ERCP组和保守治疗组入院时的白细胞计数、中性粒细胞计数、C-反应蛋白、降钙素原均显著高于对照组,淋巴细胞计数、白蛋白均显著低于对照组(P<0.05),且上述指标ERCP组和保守治疗组变化无统计学意义 (P>0.05)。在ERCP组和保守治疗组中,术后1 d血浆白蛋白水平低于术前1 d(P<0.05),但是术后3 d、术后7 d显著高于术前1 d,且ERCP组术后术后3 d、术后7 d血浆白蛋白水平显著高于保守治疗组 (P<0.05)。在ERCP组治疗的总有效率显著高于保守治疗组（P<0.05）;两组并发症发生率对比无统计学意义（P>0.05）。在ERCP组中,选取白蛋白、降钙素原水平等因素,通过logistic回归分析证实白蛋白、降钙素原为影响患者预后的主要危险因素(P<0.05)。结论：急性胰腺炎患者经内镜逆行胰胆管造影手术前后血浆白蛋白水平有显著波动,白蛋白、降钙素原与患者预后显著相关,可预测患者的预后。     

复发性胆源性胰腺炎的临床特征及危险因素分析

目的:研究复发性胆源性胰腺炎(RGP)的临床特征及危险因素。方法:选择从2012年1月至2017年1月在本院接受治疗的80例RGP患者作为观察组,另选同期在本院接受治疗的胆源性胰腺炎(GP)患者86例作为对照组,分析观察组患者的临床特征及两组患者的致病因素,采用Logistic回归分析RGP的危险因素。结果:在RGP患者的临床特征中,复发次数均较多,平均达到(3.21±0.23)次。发病诱因则主要是胆囊结石、胆总管结石及高脂血症;临床症状主要是黄疸、呕吐、恶心、腹痛、腹胀;并发症主要包括胆管炎、胰腺脓肿以及腹水;临床体征主要有出血征象、腹肌紧张、腹部压痛等。观察组的男性、重度胰腺炎、合并胆总管结石、胆胰管开口狭窄、有高脂血症、手术治疗的患者致病率分别高于对照组,并且观察组急性生理与慢性健康评分(APACHE-Ⅱ)明显高于对照组,差异均有统计学意义(P0.05)。由多因素Logistic回归分析可知,导致RGP的危险因素有男性、高APACHE-Ⅱ评分、重度胰腺炎、合并胆总管结石、胆胰管开口狭窄、有高脂血症以及手术治疗。结论:RGP患者的临床特征具有一定的规律性,其中男性、高APACHE-Ⅱ评分、重度胰腺炎、合并胆总管结石、胆胰管开口狭窄、有高脂血症以及手术治疗是导致RGP发生的危险因素。