胆囊结石患者内镜保胆取石术后结石复发影响因素分析  

Analysis of the influence factors of gallstone recurrence after endoscopic gallbladder-preserving cholelithotomy

作　　者：程相超 张家明 Cheng Xiangchao;Zhang Jiaming(Department of General Surgery,Henan No.3 Provincial People’s Hospital,Zhengzhou,Henan 450017,China;Center for Diagnosis and Treatment of Digestive Disease,Henan No.3 Provincial People’s Hospital,Zhengzhou,Henan 450017,China)

机构地区：[1]河南省直第三人民医院普外科,河南郑州450017 [2]河南省直第三人民医院消化病诊疗中心,河南郑州450017

出　　处：《感染．炎症．修复》2022年第1期33-36,共4页Infection Inflammation Repair

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190856)。

摘　　要：目的:探讨影响胆囊结石患者内镜保胆取石术后结石复发的因素。方法:536例胆囊结石患者于2018年11月—2021年12月在河南省直第三人民医院行内镜保胆取石术,随访1年,根据期间腹部B超复查结果将患者分为胆囊结石复发组(n=32)和未复发组(n=504),收集患者术前临床资料,包括性别,年龄,是否合并糖尿病、胆囊息肉,是否有胆石症家族史,结石数量,胆囊壁厚度、胆囊收缩功能,血总胆固醇、甘油三酯水平。通过单因素分析和多因素Logistic回归方法分析影响内镜保胆取石术后结石复发的因素,建立风险评估模型,经受试者工作特征(ROC)曲线评估诊断效能。结果:行内镜保胆取石术的536例患者中有32例1年内结石复发;多因素Logistic回归分析表明,有胆石症家族史(P=0.018,OR=9.641)、油腻食物的饮食习惯(P=0.000,OR=24.804)、结石数量≥3个(P=0.039,OR=5.658)、胆囊收缩功能差(P=0.003,OR=6.449)以及甘油三酯水平≥1.7mmol/L(P=0.016,OR=3.789)是保胆取石术后结石复发的独立影响因素;ROC曲线分析结果表明,上述5种指标联合检测的ROC曲线下面积(AUC)值最高,为0.818,且灵敏度、特异度分别为90.62%、78.12%。结论:内镜保胆取石术治疗胆囊结石术后结石复发的风险较高,有胆石症家族史、油腻食物饮食习惯、结石数量≥3个、胆囊收缩功能差、甘油三酯水平≥1.7 mmol/L是术后患者结石复发的危险因素。行内镜保胆取石术的患者应对相关危险因素予以有效控制,以降低术后结石复发率。对于胆囊壁厚度≥4 mm或术前胆囊功能收缩异常的患者,不建议行内镜保胆取石术。Objective:To analyze the influence factors of gallstone recurrence in patients after endoscopic gallbladderpreserving cholelithotomy.Methods:The general data of 536 patients,who underwent endoscopic gallbladderpreserving cholelithotomy in Henan No.3 Provincial People’s Hospital from Nov.2018 to Dec.2021,were collected and retrospectively analyzed.These patients were followed up for 1 year,and divided into recurrence group(n=32)and non-recurrence group(n=504)according to the results of abdominal B-ultrasound.Clinical data of the patients were collected,including gender,age,diabetes mellitus,gallbladder polyps,family history of cholelithiasis,gallstone number,thickness of gallbladder wall and gallbladder contraction function,total cholesterol and triglyceride levels.Univariate analysis and multivariate logistic regression analysis was performed to analyze the factors that affect the recurrence of calculi in patients with endoscopic gallbladder-preserving cholelithotomy.The risk assessment model was established.The receiver operating curve(ROC)was used to evaluate the diagnostic efficiency of the model.Results:Of the 536 patients who underwent endoscopic gallbladder-preserving cholelithotomy,32 patients had stone recurrence within 1 year.Multivariate logistic regression analysis showed that there was a family history of cholelithiasis(P=0.018,OR=9.641),dietary habits of greasy food(P=0.000,OR=24.804),number of stones≥3(P=0.039,OR=5.658),poor gallbladder contraction function(P=0.003,OR=6.449)and TG level≥1.7 mmol/L(P=0.016,OR=3.789)were the independent influencing factors of stone recurrence after endoscopic gallbladder-preserving cholelithotomy.The result of ROC curve analysis showed that the area under ROC curve(AUC)value of the combined detection of the above five indicators was the highest(0.818),and the sensitivity and specificity were 90.62%and 78.12%respectively.Conclusions:There is a high risk of gallstone recurrence after endoscopic gallbladder-preserving cholelithotomy.The family history of cholelithi

关 键 词：胆囊结石 内镜保胆取石术 复发 影响因素 

分 类 号：R575.6[医药卫生—消化系统] R575.62[医药卫生—内科学]