内镜取石术后胆总管结石复发的风险分析及防治策略  

Risk analysis and prevention strategy of recurrent choledocholithiasis after endoscopic retrograde cholangiopacreatography

作　　者：于志远 杨诗语 孙相钧 孙岩[1] Yu Zhiyuan;Yang Shiyu;Sun Xiangjun;Sun Yan(Department of General Surgery,Second Affiliated Hospital,Harbin Medical University,Heilongjiang Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属第二医院普外七科,黑龙江哈尔滨150081

出　　处：《腹部外科》2021年第4期314-317,共4页Journal of Abdominal Surgery

基　　金：黑龙江省自然科学基金(H2016028)。

摘　　要：结石复发是经内镜逆行胰胆管造影(endoscopic retrograde cholangiopacreatography, ERCP)取石术后常见的远期并发症,其发病机制尚未完全明确,风险因素众多且复杂。目前认为胆管内胆汁淤积及细菌感染是结石复发的主要发病机制。胆总管扩张或成角、壶腹周围憩室、胆道支架置入、多次ERCP操作及括约肌切开、结石大和数量多、碎石操作是常见的风险因素。针对其病因及危险因素采取有效的防治措施,将有效降低结石复发的发病率,明显改善病人预后。Recurrent choledocholithiasis is one of the most common long-term complications after endoscopic retrograde cholangiopacreatography(ERCP).The pathogenesis of recurrent choledocholithiasis after ERCP has remained elusive while the risk factors are numerous and complex.Currently cholestasis and bacterial infection in bile duct are considered as two major pathogenetic factors of stone recurrence.Dilated common duct,angulated bile duct,periampullary diverticula(PAD),stenting,multiple ERCP,endoscopic sphincterotomy(EST),large stone,multiple stones and mechanical lithotripsy are frequently reported risk factors of recurrent choledocholithiasis.Taking effective preventive and therapeutic measures for etiology and risk factors may effectively reduce the incidence of recurrent choledocholithiasis and significantly improve the prognosis of patients.

关 键 词：内镜取石 胆总管结石复发 发病机制 风险因素 防治策略 

分 类 号：R619.9[医药卫生—外科学]