内镜逆行性胰胆管造影术取石后胆总管结石复发的危险因素分析
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摘要
目的研究分析内镜逆行性胰胆管造影术(ERCP)取石后胆总管结石复发的危险因素,为临床预防ERCP术后胆总管结石复发提供参考依据。方法选择我院行ERCP取石治疗的200例胆总管结石患者(2016年1月～2017年8月),对其临床资料进行回顾性分析,统计术后随访1年内患者的胆总管结石复发情况,将其分为复发组与无复发组,分析胆总管结石患者在ERCP取石术后复发胆总管结石的危险因素。结果200例胆总管结石患者在ERCP取石术后1年内,共复发39例,其复发率为19.50%。经单因素分析、多因素Logistic回归分析,年龄≥60岁、BMI指数≥25kg/m~2、既往胆道手术史、胆总管结石数量≥2枚、胆总管结石直径≥10mm、胆总管扩张、乳头旁憩室是导致胆总管结石患者在ERCP取石术后复发胆总管结石的危险因素。结论胆总管结石患者ERCP取石术后胆总管结石复发的危险因素为年龄、BMI指数、既往胆道手术史、胆总管结石数量、胆总管结石直径、胆总管扩张、乳头旁憩室,可根据其危险因素采取完善手术方案、减少结石残留、术后控制饮食等措施进行预防。
Objective To study risk factors risk factors for recurrence of choledocholithiasis after stone removal by endoscopic retrograde cholangiopancreatography(ERCP) in order to provide reference for clinical prevention of recurrent choledocholithiasis after ERCP. Methods Clinical data of 200 patients with choledocholithiasis who were treated with ERCP in our hospital from January 2016 to August 2017 were analyzed retrospectively and the recurrence of choledocholithiasis of patients within one-year followed-up after surgery was recorded.They were divided into recurrent group and non-recurrent group.The risk factors for recurrent choledocholithiasis after stone removal by ERCP were analyzed. Results In 200 patients of choledocholithiasis,39 patients recurred within 1 year after ERCP,with a recurrence rate of 19.50%.According to the univariate analysis and multi-factor Logistics linear regression analysis,age equal to or over 60 years old,BMI index equal to over 25 kg/m~2,previous history of biliary tract surgery,number of choledocholithiasis equal to or over 2,diameter of choledocholithiasis equal to or over 10 mm,choledochectasia and peripapillary diverticulum were the risk factors leading to recurrence of choledocholithiasis after stone removal by ERCP. Conclusion Risk factors for recurrence of choledocholithiasis after stone removal by ERCP are age,BMI index,previous history of biliary tract surgery,number of choledocholithiasis,diameter of choledocholithiasis,choledochectasia and peripapillary diverticulum.According to its risk factors,it can take measures to prevent by improving the operation plan,reducing the stone residue and controlling the diet after the operation.
Objective To study risk factors risk factors for recurrence of choledocholithiasis after stone removal by endoscopic retrograde cholangiopancreatography(ERCP) in order to provide reference for clinical prevention of recurrent choledocholithiasis after ERCP. Methods Clinical data of 200 patients with choledocholithiasis who were treated with ERCP in our hospital from January 2016 to August 2017 were analyzed retrospectively and the recurrence of choledocholithiasis of patients within one-year followed-up after surgery was recorded.They were divided into recurrent group and non-recurrent group.The risk factors for recurrent choledocholithiasis after stone removal by ERCP were analyzed. Results In 200 patients of choledocholithiasis,39 patients recurred within 1 year after ERCP,with a recurrence rate of 19.50%.According to the univariate analysis and multi-factor Logistics linear regression analysis,age equal to or over 60 years old,BMI index equal to over 25 kg/m~2,previous history of biliary tract surgery,number of choledocholithiasis equal to or over 2,diameter of choledocholithiasis equal to or over 10 mm,choledochectasia and peripapillary diverticulum were the risk factors leading to recurrence of choledocholithiasis after stone removal by ERCP. Conclusion Risk factors for recurrence of choledocholithiasis after stone removal by ERCP are age,BMI index,previous history of biliary tract surgery,number of choledocholithiasis,diameter of choledocholithiasis,choledochectasia and peripapillary diverticulum.According to its risk factors,it can take measures to prevent by improving the operation plan,reducing the stone residue and controlling the diet after the operation.
引文
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[12]庞琬玉,王帆,赵秋,等.ERCP术后胆总管结石复发危险因素的Meta分析[J].海南医学,2017,28(21):3584-3589.
[13]周玮,赖晓伟,刘杰,等.内镜治疗后胆总管结石多次复发危险因素的初步分析[J].中华消化杂志,2015,35(9):620-623.
[14]汪润芝,邓涛.胆总管结石经内镜逆行胰胆管造影术取石迟发出血的危险因素分析及防治[J].中华消化内镜杂志,2015,32(7):452-456.
[15]王春秋,马颖才,朱志勇,等.经内镜逆行胰胆管造影术后胆总管结石复发的危险因素分析[J].临床肝胆病杂志,2017,33(2):297-299.
[2]Itoi T,Watanabe H,Gotoda T,et al.Therapeutic endoscopic retrograde cholangiopancreatography using a large dilating balloon in a patient with upside-down stomach and bile duct stones(with video)[J].Journal of Hepato-biliary-pancreatic Sciences,2015,22(2):177-179.
[3]林萍(综述),邓涛(审校).内镜逆行性胰胆管造影术后胆总管结石复发的成因分析及防治对策[J].疑难病杂志,2015,14(5):540-543.
[4]唐万峰,依玛木买买提江·阿布拉,王海久,等.胆总管结石患者的内镜逆行胰胆管造影联合内镜括约肌切开术取石的效果研究[J].中国内镜杂志,2016,22(5):47-51.
[5]邹瑞,杨玉龙,祁春春,等.内镜逆行胰胆管造影取石术与开腹手术治疗胆总管结石的疗效对比研究[J].中华普通外科杂志,2014,29(11):857-859.
[6]李作安,张建民,钱长春,等.逆行胰胆管造影联合内镜与腹腔镜联合胆道镜治疗单纯胆总管结石的临床效果[J].中国医药导报,2016,13(28):56-59.
[7]Fujinami H,Kajiura S,Ando T,et al.Direct Spraying of Shakuyakukanzoto onto the Duodenal Papilla:A Novel Method for Preventing Pancreatitis following Endoscopic Retrograde Cholangiopancreatography[J].Digestion,2015,91(1):42-45.
[8]姚璜,王红玲,廖雯婓,等.经内镜逆行性胰胆管造影术取石后胆道结石复发的危险因素的Meta分析[J].临床消化病杂志,2017,29(1):27-32.
[9]孟环.ERCP取石后胆总管结石复发的相关危险因素研究[J].河北医药,2016,22(5):716-718.
[10]孟环.ERCP取石后胆总管结石复发的相关危险因素研究[J].肝胆外科杂志,2015,23(3):203-206.
[11]赖晓伟,周玮,刘杰,等.胆总管结石内镜治疗复发的危险因素分析[J].中华消化内镜杂志,2015,32(9):600-603.
[12]庞琬玉,王帆,赵秋,等.ERCP术后胆总管结石复发危险因素的Meta分析[J].海南医学,2017,28(21):3584-3589.
[13]周玮,赖晓伟,刘杰,等.内镜治疗后胆总管结石多次复发危险因素的初步分析[J].中华消化杂志,2015,35(9):620-623.
[14]汪润芝,邓涛.胆总管结石经内镜逆行胰胆管造影术取石迟发出血的危险因素分析及防治[J].中华消化内镜杂志,2015,32(7):452-456.
[15]王春秋,马颖才,朱志勇,等.经内镜逆行胰胆管造影术后胆总管结石复发的危险因素分析[J].临床肝胆病杂志,2017,33(2):297-299.