内镜下胆总管取石术后胆总管结石复发的危险因素研究  

Analysis of risk factors of recurrence of common bile duct stones after endoscopic retrograde cholangiopancreatography

作　　者：梁亭亭 吴承荣 李旭 车金标[2] 黄留业[2] LIANG Tingting;WU Chengrong;LI Xu;CHE Jinbiao;HUANG Liuye(Department of Medicine,Qingdao University,Qingdao,Shandong,266071,China;Department of Gastroenterology,the Affiliated Yantai Yuhuangding Hospital of Qingdao University)

机构地区：[1]青岛大学医学部,山东青岛266071 [2]青岛大学附属烟台毓璜顶医院消化内科

出　　处：《中国中西医结合消化杂志》2023年第2期136-141,共6页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

摘　　要：目的:研究经内镜逆行胰胆管造影术(ERCP)中改良的内镜括约肌切开术(sEST)联合内镜乳头气囊扩张术(EPBD)术后胆总管结石复发的相关危险因素,为临床监测提供参考依据。方法:回顾性分析2018年1月—2020年4月就诊于青岛大学附属烟台毓璜顶医院并行sEST+EPBD取石治疗的胆总管结石患者的临床资料。共入组406例患者,根据ERCP胆总管取石术后胆总管结石是否复发分为复发组(n=140)和无复发组(n=266),对可能影响胆总管结石复发的相关因素进行多因素分析。结果:经过平均37.65个月的随访,发现406例sEST+EPBD取石术后胆总管结石复发患者共140例,结石复发率为34.5%。糖尿病、年龄、初次病程、谷丙转氨酶、胆道感染、胆囊状态、胆总管直径、多发结石(结石个数≥2)、大的胆总管结石(最大胆总管结石直径≥12 mm)、泥沙样结石、机械碎石的应用及胆道支架植入为ERCP取石术后胆总管结石复发的危险因素(P<0.05);糖尿病、年龄≥65岁、首次病程>3 d、胆道感染、胆囊切除、结石数量≥2个是ERCP术后胆总管结石复发的独立危险因素。结论:糖尿病、年龄≥65岁、首次病程>3 d、胆道感染、胆囊切除、结石数量≥2个是ERCP术后胆总管结石复发的独立危险因素。Objective:To investigate the related risk factors of recurrent common bile duct(CBD)stones after small endoscopic sphincterotomy combined with endoscopic papillary balloon dilation(sEST+EPBD),then provide a reference for clinical mornitoring.Methods:A retrospective analysis was made of 406 patients with choledocholithiasis underwent endoscopic retrograde cholangiopancreatography from January 2018 to April 2020.According to the recurrence of CBD stones,the patients were divided into a recurrence group(n=140)and a non-recurrence group(n=266),and a multivariate analysis was performed to determine the factors that might influence recurrence of choledocholithiasis.Results:A total of 406 patients were followed up with a mean duration of 37.65 months,with 140 patients in recurrent group,the recurrence rate is 34.5%.Diabetes,age,initial course of disease,alanine aminotransferase(ALT),biliary duct infection,history of cholecystectomy,diameter of CBD stones,multiple choledocholithiasis(≥2),the diameter of choledocholithiasis≥12 mm,muddy stone,mechanical lithotripsy under endoscope,and CBD stones stent implantation were risk factors for recurrence of choledocholithiasis after ERCP(P<0.05).Multivariate analysis showed that diabetes,age≥65 years,initial course of disease>3 d,biliary duct infection,history of cholecystectomy and multiple choledocholithiasis(≥2)were the independent risk factors for recurrence of choledocholithiasis after ERCP(P<0.05).Conclusion:This study confirmed that diabetes,age≥65 years,initial course of disease>3 d,biliary duct infection,history of choledochotomy and multiple choledocholithiasis(≥2)were independent risk factors for recurrence of CBD stones after ERCP.

关 键 词：胆总管结石 内镜逆行胰胆管造影术 内镜括约肌切开术 内镜乳头气囊扩张术 复发 危险因素 

分 类 号：R657.42[医药卫生—外科学]