十二指肠壶腹部及胆道解剖结构异常对内镜胆总管取石术后结石复发的影响  

Correlation between anatomical structure and recurrence of common bile dust stones after endoscopic choledochlithotomy

作　　者：刘苗[1] 邓涛[1] 

机构地区：[1]武汉大学人民医院消化内科,武汉430060

出　　处：《中华消化内镜杂志》2015年第5期286-289,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨十二指肠壶腹部及胆道解剖结构异常与内镜胆总管取石术后结石复发的相关性。方法对195例胆总管结石行内镜取石患者的临床资料进行回顾性分析，包括37例取石术后胆总管结石复发患者，采用单因素和多因素分析方法，分析内镜胆总管取石术后结石复发与解剖结构性因素的相关性。结果单因素分析显示，胆囊切除术后、胆总管切开取石术后、十二指肠壶腹周围憩室、十二指肠乳头肥厚、十二指肠乳头狭窄、十二指肠壁内段胆管过长、胆总管狭窄、胆总管扩张、胆总管弯曲成角是内镜胆总管取石术后结石复发的解剖结构性危险因素。多因素Logistic回归法分析显示，胆囊切除术后、十二指肠壶腹周围憩室、胆总管扩张、胆总管弯曲成角是内镜胆总管取石术后结石复发的解剖结构性独立危险因素。结论胆总管结石患者，如存在胆囊切除术史或十二指肠壶腹周围憩室或胆总管扩张或胆总管弯曲成角，内镜取石术后胆总管结石易复发。Objective To investigate the correlation between anatomical structure and recurrence of common bile duct stones. Methods The clinical data of 195 patients with common bile duct stones were studied, including 37 patients with recurrent bile duct stones. The correlation between anatomical structure and the recurrence of common bile duct stones were analyzed by univariate and multivariate analysis. Results Univariate analysis revealed that history of cholecystectomy, choledocholithotomy, periampullar diverticulum, papilla hypertrophy or stenosis, intramural duodenal bile duct abnormalities, common bile duct stricture, choledochectasia and angulated common bile dust were risk factors of recurrence. Multivariate logistic regression analysis showed that past history of cholecystectomy, periampullary diverticulum, angulated common bile dust, choledochectasia were independent risk factors for the recurrence of common bile duct stones. Conclusion Patients with anatomical structure of past cholecystectom, periampullary diverticulum, choledochectasia, angulated common bile dust are prone to recurrence of common bile duct stones.

关 键 词：胰胆管造影术 内窥镜逆行 胆总管结石 复发 解剖结构异常 

分 类 号：R657.4[医药卫生—外科学]