胆总管结石内镜治疗复发的危险因素分析  

Risk factors for recurrence after endoscopic treatment of common bile duct stones

作　　者：赖晓伟[1] 周玮[1] 刘杰[1] 邹多武[1] 

机构地区：[1]第二军医大学长海医院消化内科,上海200433

出　　处：《中华消化内镜杂志》2015年第9期600-603,共4页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨胆总管结石经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）取石成功后结石复发的相关危险因素。方法收集2007年7月至2011年12月因胆总管结石住院行内镜取石的患者资料，记录患者的性别、年龄、胆囊切除史、胆总管直径、结石数量、胆囊结石、乳头旁憩室、碎石术、鼻胆管引流术等9个相关因素，并对患者进行随访，观察患者术后结石复发情况。对相关因素行多因素Logistic回归分析，了解内镜治疗后胆总管结石复发的危险因素。结果成功随访1699例患者，平均随访时间55．6个月，134人复发，结石复发率7．9％，平均复发时间为24个月。单因素分析显示胆管直径≥13mm、胆囊切除史、多发结石（结石数量≥2）、碎石术与结石复发相关。多因素分析显示胆管直径≥13mm（OR=1．607，95％CI：1．051～2．456，P=0．028）、胆囊切除史（OR=7．101，95％CI：4．539～11．108，P=0．001）、胆囊结石（OR=2．441，95％CI：1．417—4．206，P=0．001）为结石复发的独立危险因素。结论胆囊切除史、胆管直径≥13mm、合并胆囊结石为结石复发的独立危险因素。Objective To investigate the risk factors for recurrence of common bile duct （CBD） stones after treatment with ERCP. Methods Data of patients who underwent ERCP from July 2007 to December 2011 for CBD stones were collected. The risk factors for recurrence including gender, age,history of cholecystectomy,diameter of CBD, number of stones, gallstones, papillary diverticulum, lithotripsy and endoscopic nasobiliary drainage were assessed by univariate analysis and multivariate logistic regression analysis. Follow-up was conducted to retrospectively investigate stone recurrence rate. Results A total of 1 699 patients were followed up with a mean duration of 55. 6 months. There were 134（7. 9% ） patients with stone recurrence over a mean duration of 24 months. The univariate analysis showed that diameter of CBD ≥ 13 mm, history of cholecystectomy, number of stones ≥2, lithotripsy were related to CBD stone recurrence. Multivariate analysis showed diameter of CBD i〉 13 mm （ OR = 1. 607,95% CI： 1. 051-2. 456, P = 0. 028 ）, history of cholecystectomy （ OR = 7. 101,95 % CI：4. 539-11. 108, P = 0. 001 ） , gallstones （ OR = 2. 441,95 % CI： 1. 417-4. 206, P = 0. 001 ） were independent risk factors for recurrence of CBD stones. Conclusion Diameter of CBD≥ 13 ram,history of cholecystectomy, gallstones are independent risk factors for recurrence of CBD stones.

关 键 词：胆总管结石 胰胆管造影术 内窥镜逆行 复发 危险因素 回顾性研究 

分 类 号：R657.4[医药卫生—外科学]