胆道支架置入术对内镜下逆行胰胆管造影取石术后结石复发率和胆管炎发生率的影响及术后结石复发的影响因素分析  

Analysis effect of biliary stent implantation on the incidence of stone recurrence and cholangitis after endoscopic retrograde cholangiopancreatography and the influencing factors of stone recurrence after operation

作　　者：李凯 戴欢[1] 谢健[1] LI Kai;DAI Huan;XIE Jian(Department of Gastroenterology,Zhangjiagang first people's Hospital,Zhangjiagang,Jiangsu,21560,China)

机构地区：[1]张家港市第一人民医院消化科,江苏张家港215600

出　　处：《当代医学》2023年第36期29-33,共5页Contemporary Medicine

摘　　要：目的分析胆道支架置入术对内镜下逆行胰胆管造影(ERCP)取石术后结石复发率和胆管炎发生率的影响及术后结石复发的影响因素。方法回顾性分析2016年9月至2020年8月于张家港市第一人民医院行ERCP取石治疗的320例胆总管结石患者的临床资料,根据是否置入胆道支架分为观察组(n=126)与对照组(n=194)。比较两组临床资料、随访时间、结石复发率及术后胆管炎发生率,采用单因素及多因素Logistic回归分析术后结石复发的影响因素。结果两组年龄、性别、胆囊切除情况、壶腹周围憩室情况比较差异无统计学意义;观察组内镜下乳头括约肌切开术(EST)+EPBD、多发性结石、机械碎石比例均明显高于对照组,结石直径大于对照组,手术时间长于对照组,差异有统计学意义(P<0.05)。320例患者中,出现结石复发35例,术后胆管炎18例,结石复发率及术后胆管炎发生率分别为10.9%、5.6%。两组随访时间比较差异无统计学意义;观察组结石复发率、术后胆管炎发生率均低于对照组,差异有统计学意义(P<0.05)。结石复发患者与结石未复发患者年龄、性别、胆囊切除情况、ERCP方法、壶腹周围憩室情况、手术时间比较差异无统计学意义;结石复发患者多发性结石、机械碎石、未行胆道支架置入术比例均高于结石未复发患者,结石直径长于结石未复发患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,多发性结石是ERCP取石术后结石复发的危险因素(OR>1,P<0.05),胆道支架置入术是ERCP术后结石复发的独立预后因素(OR<1,P<0.05)。结论胆道支架置入术能有效降低ERCP术后结石复发率和胆管炎发生率。Objective To analyze the effect of biliary stent placement on the incidence of stone recurrence and cholangitis after endoscopic retro-grade cholangiopancreatography(ERCP),and the influencing factors of stone recurrence after operation.Methods The clinical data of 320 patients with choledocholithiasis who underwent ERCP stone removal treatment at the First People's Hospital of Zhangjiagang City from September 2016 to August 2020 were retrospective analyzed,they were divided into the observation group(n=126)and the control group(n=194)according to whether or not biliary stents were inserted.The clinical data,follow-up time,and incidence of stone recurrence and postoperative cholangitis were compared between two groups,and Univariate and multivariate Logistic regression were used to analyze the influencing factors of stone recurrence after opera-tion.Results There was no significant difference in age,gender,gallbladder status and periampullary diverticulum between the two groups;the pro-portion of endoscopic sphincterotomy(EST)+EPBD,multiple stones and mechanical lithotrite in the observation group was significantly higher than that in the control group,the stone diameter was larger than that in the control group,and the operation time was longer than that in the control group,and the differences were statistically significant(P<0.05).Among the 320 patients,35 cases had stone recurrence and 18 cases had postoperative cholangitis,the incidence of stone recurrence and postoperative cholangitis were 10.9%and 5.6%,respectively.There was no significant difference in follow-up time between the two groups;the incidence of stone recurrence and postoperative cholangitis in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in age,gender,cholecystec-tomy,ERCP method,periampullary diverticulum and operative time between patients with recurrent stones and non-recurrent calculi;the proportion of multiple calculi,mechanic

关 键 词：胆道支架置入术 内镜下逆行胰胆管造影 胆总管结石 胆管炎 

分 类 号：R657.4[医药卫生—外科学]