经皮胆囊碎石术后结石复发439例随访分析  

Recurrence of cholecystolithiasis after successful percutaneous cholecystolithotomy: follow-up results of 439 cases

作　　者：邹一平[1] 杜继东[1] 李为民[1] 萧荫祺[1] 许红兵[1] 郑方[1] 黄辉[1] 刘浩润[1] 李虎成[1] 

机构地区：[1]解放军总医院第二附属医院肝胆外科,北京100091

出　　处：《消化外科》2006年第5期329-332,共4页Journal of Digestive Surgery

摘　　要：目的 探讨经皮胆囊碎石术（PCCL）后长期临床预后和结石复发情况，了解与结石复发的相关因素。方法 对439例PCCL患者随访10年，评估结石复发率和临床预后。结果 439例患者中182例结石复发，总复发率41．46％，术后1～10年结石累计复发率分别为9．57％、18．91％、27．33％、34．14％、37．59％、39．86％、41．90％、42．73％、42．85％和43．21％。182例结石复发患者中，94例无症状，80例表现有非特异性上消化道不适症状，8例有上腹痛或胆绞痛，其中38例行胆囊切除术治疗。与结石复发相关的因素包括胆囊结石家族史、喜好油腻食品、伴发肝病、PCCL术前复发胆囊结石和胆囊功能不全。结论 PCCL术后结石复发不可避免，术后前6年结石复发率逐年增加明显，随后增长缓慢，术后10年约50％的患者无结石复发。一些危险因素与结石复发有关。PCCL可作为高龄和高危胆囊结石患者有价值的治疗选择，治疗其他胆囊结石患者尚需慎重选择。Objective To explore the long-term recurrence rate of cholecystolithiasis and clinical outcome after successful percutaneous cholecystolithotomy （PCCL） and investigate the possible risk factors relating to recurrence of cholecystolithiasis, Methods A total of 439 cases treated with PCCL were followed up for 10 years to evaluate the long-term recurrence rate of cholecystolithiasis and clinical outcome after successful PCCL and statistically analyze some risk factors associated with recurrence of cholecystolithiasis. Results Recurrence of cholecystolithiasis was detected in 182 out of 439 cases, with overall recurrence rate of 41. 46%. The cumulative proportion of cholecystolithiasis recurrence at 1-10 years was 9.57%, 18.91%, 27. 33%, 34. 14%, 37.59%, 39.86%, 41. 90%, 42.73%, 42.85% and 43.21% respectively. Of 182 cases with recurrence of cholecystolithiasis, 94 remained asymptomatic, 80 stated nonspecific upper gastrointestinal symptoms and 8 had abdominal pain or biliary colic, of which 38 were treated with cholecystectomy. The risk factors relating to recurrence of cholecystolithiasis included the family history of cholecystolithiasis, favor to fatty food, liver disease, recurrent cholecystolithiasis and gallbladder dysfunction before PCCL. Conclusions Recurrence of cholecystolithiasis is inevitable after a successful PCCL. The frequency of cholecystolithiasis recurrence seems to increase obviously at the first 6 years after PCCL and then slowly decrease. About 50% of cases after PCCL are free from cholecystolithiasis recurrence 10 years after PCCL. Some risk factors are associated with cholecystolithiasis recurrence. PCCL offers a valuable therapeutic alternative to conventional surgery for elderly and cases with high risk cholecystolithiasis but should be careful for other cases with cholecystolithiasis.

关 键 词：胆囊结石 经皮胆囊碎石术 复发 危险因素 

分 类 号：R657.42[医药卫生—外科学]