老年胆总管结石合并急性胆管炎患者ERCP术后胆总管结石复发的危险因素分析  

Risk factors of choledocholithiasis recurrence in elderly patients with acute cholangitis after ERCP surgery

作　　者：冯其柱 陈先志 孙杰[1] 张健[1] 王琦[1] FENG Qizhu;CHEN Xianzhi;SUN Jie;ZHANG Jian;WANG Qi(Department of General Surgery,the First Affiliated Hospital of Anhui University of Science and Technology,Huainan 232007,China)

机构地区：[1]安徽理工大学第一附属医院普外科,安徽淮南232007

出　　处：《实用医学杂志》2023年第15期1945-1949,共5页The Journal of Practical Medicine

基　　金：安徽高校自然科学研究基金资助重点项目(编号:KJ2021A0439);淮南市第九批“50·科技之星”创新团队;淮南市指导性科技计划项目(编号:2021066)。

摘　　要：目的 探讨老年胆总管结石合并急性胆管炎患者急诊行内镜取石术后胆总管结石复发危险因素。方法 回顾性分析2018年1月至2022年10月安徽理工大学第一附属医院收治的年龄≥60岁患胆总管结石合并急性胆管炎行内镜逆行胰胆管造影(ERCP)、乳头括约肌小切开术(sEST)联合内镜下乳头球囊扩张术(EPBD)治疗的患者临床资料。根据术后随访胆总管结石是否有复发分为复发组和非复发组。对比两组胆总管结石患者临床资料,分析胆总管结石复发危险因素。结果 胆总管结石复发率为18.52%(20/108)。单因素分析发现,十二指肠乳头旁憩室、胆道支架、胆总管结石数≥2枚和机械碎石是内镜下取石术后胆总管结石复发的危险因素(P <0.05)。多因素Logistic回归分析显示,胆道支架、胆总管结石数≥2和机械碎石是内镜下取石术后胆总管结石后复发的独立危险因素(P <0.05)。而术后服用熊去氧胆酸6个月可以减少胆总管结石复发(P <0.05)。结论 胆道支架、胆总管结石数≥2枚和机械碎石是老年胆总管结石合并急性胆管炎行内镜下取石术后胆总管结石复发的独立危险因素,而术后服用熊去氧胆酸半年有利于减少胆总管结石复发。Objective To investigate the risk factors for choledocholithiasis recurrence after emergency endoscopic choledocholithotomy in elderly patients with choledocholithiasis complicated with acute cholangitis.Methods The clinical data of patients aged over 60 years with choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography(ERCP),small sphincterotomy(sEST) combined with endoscopic balloon dilation of the nipple(EPBD) in the First Affiliated Hospital of Anhui University of Science and Technology from January 2018 to October 2022 were retrospectively analyzed.According to the postoperative follow-up of choledocholithiasis recurrence,the patients were divided into recurrence group and non-recurrence group.The clinical data of patients with choledocholithiasis were compared between the two groups to analyze the risk factors of choledocholithiasis recurrence.Results The recurrence rate of choledocholithiasis was 18.52%(20/108).Univariate analysis showed that parapillary duodenal diverticulum,biliary stent,number of common bile duct stones ≥ 2 pieces and mechanical lithotripsis were risk factors for recurrence of common bile duct stones after endoscopic stone removal(P<0.05).Multifactor Logis-tic regression analysis showed that biliary stents,the number of common bile duct stones ≥ 2 pieces and mechanical lithotripsy were independent risk factors for the recurrence of common bile duct stones after endoscopic lithotomy(P<0.05).Ursodeoxycholic acid for 6 months after surgery could reduce the recurrence of choledocholithiasis(P<0.05).Conclusion Biliary stents,the number of choledocholithiasis ≥ 2 pieces and mechanical lithotripsy were independent risk factors for choledocholithiasis recurrence in elderly patients after endoscopic lithotomy,and ursodeoxycholic acid for six months after surgery was beneficial to reduce choledocholithiasis recurrence.

关 键 词：胆总管结石病 内镜逆行胰胆管造影 复发 危险因素 

分 类 号：R657.4[医药卫生—外科学]