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中华普通外科学文献(电子版) ›› 2018, Vol. 12 ›› Issue (06) : 400 -404. doi: 10.3877/cma.j.issn.1674-0793.2018.06.008

所属专题: 文献

论著

胆囊切除对内镜下逆行胰胆管造影术后胆管炎复发的预防
焦振东1, 刘益民2, 胡羽进2,()   
  1. 1. 721000 陕西省宝鸡市人民医院肝胆外科
    2. 721000 陕西省宝鸡市人民医院重症医学科
  • 收稿日期:2018-05-23 出版日期:2018-12-01
  • 通信作者: 胡羽进

Prevention of recurrence of cholangitis after endoscopic retrograde cholangiopancreatography bycholecystectomy

Zhendong Jiao1, Yimin Liu2, Yujin Hu2,()   

  1. 1. Department of Hepatobiliary Surgery, Shaanxi Baoji People's Hospital, Baoji 721000, China
    2. Department of Intensive Care Unit, Shaanxi Baoji People's Hospital, Baoji 721000, China
  • Received:2018-05-23 Published:2018-12-01
  • Corresponding author: Yujin Hu
  • About author:
    Corresponding author: Hu Yujin, Email:
引用本文:

焦振东, 刘益民, 胡羽进. 胆囊切除对内镜下逆行胰胆管造影术后胆管炎复发的预防[J/OL]. 中华普通外科学文献(电子版), 2018, 12(06): 400-404.

Zhendong Jiao, Yimin Liu, Yujin Hu. Prevention of recurrence of cholangitis after endoscopic retrograde cholangiopancreatography bycholecystectomy[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(06): 400-404.

目的

探讨胆管结石合并胆管炎经内镜下逆行胰胆管造影术(ERCP)清除结石后,行胆囊切除术对减少胆管炎复发的作用。

方法

选择2010年1月至2017年10月间宝鸡市人民医院收治的1 000例胆管结石合并胆管炎患者,并分为对照组502例(常规ERCP清除胆管结石)和胆囊切除组498例(在上述治疗基础上给予开腹或腹腔镜胆囊切除术)。回顾性分析两组患者的基本临床资料、结石情况及胆管炎复发率,采用Kaplan-Meier法分析累积复发率及胆管炎相关不良事件发生率,胆管炎复发的影响因素先进行单因素分析再进行非条件多因素Logistic回归分析。

结果

两组患者基础资料比较差异无统计学意义。术后胆管炎复发277例,包括对照组175例(34.9%),胆囊切除组102例(20.5%)。胆囊切除组患者的胆管炎复发率及胆管炎相关不良事件发生率显著低于对照组,差异有统计学意义(χ2=2.031、5.035,P=0.034、0.001)。单因素分析和Logistic回归分析结果显示,年龄、结石数量、结石最大直径、胆总管扩张、术后并发症以及是否行胆囊切除术是胆管炎复发的独立因素(均P<0.05)。

结论

经ERCP清除胆管结石后行胆囊切除术能够显著降低胆管结石合并胆管炎患者的胆管炎复发率,值得临床关注。

Objective

To investigate the effect of cholecystectomy on reducing the recurrence of cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis and cholangitis.

Methods

A retrospective analysis of one thousand cases with cholelithiasis and cholangitis admitted in Shaanxi Baoji People's Hospital from January 2010 to October 2017 was carried out. They were divided into control group (502 cases, conventional removal of bile duct stone with ERCP) and cholecystectomy group (498 cases, open or laparoscopic cholecystectomy based on the above treatment). The basic clinical data, stone situation and the recurrence of cholangitis were compared between the two groups. Cumulative relapse rate and incidence of adverse events related to cholangitis were analyzed by Kaplan-Meier method. The factors influencing recurrence of cholangitis were analyzed by univariate factor analysis and unconditional multivariate Logistic regression analysis.

Results

There were no significant differences in basic clinical data between the two groups. Postoperative cholangitis recurred in 277 cases, including 175 cases (34.9%) in the control group, and 102 cases (20.5%) in the cholecystectomy group. The recurrence rate of cholangitis and the incidence of adverse events related to cholangitis in the cholecystectomy group were significantly lower than those in the control group (χ2=2.031, 5.035; P=0.034, 0.001). Univariate analysis and Logistic regression analysis showed that age, number of stones, maximum diameter of stones, dilatation of common bile duct, postoperative complications and cholecystectomy were independent factors for the recurrence of cholangitis (all P<0.05).

Conclusion

Cholecystectomy after removal of cholelithiasis by ERCP can significantly reduce the recurrence rate of cholangitis in patients with cholelithiasis and cholangitis.

表1 两组胆管结石合并胆管炎患者基线资料均衡性比较
图1 Kaplan-Meier法分析两组胆管结石合并胆管炎患者的复发情况 A为两组患者的累积复发率比较;B为胆管炎相关不良事件发生率比较
表2 影响胆管结石术后胆管炎复发的单因素分析(例)
表3 影响胆管结石术后胆管炎复发的Logistic多因素回归分析
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