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中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 224 -228. doi: 10.3877/cma.j.issn.1674-0793.2019.03.012

所属专题: 文献

论著

经内镜逆行胰胆管造影联合腹腔镜胆囊切除术后胆囊结石合并胆总管结石复发的危险因素分析
王雷鸣1, 陈晨1,(), 丁辉1, 殷秀玲1, 仲启龙1, 司敏1   
  1. 1. 223600 宿迁,江苏省沭阳县人民医院普外科
  • 收稿日期:2018-06-09 出版日期:2019-06-01
  • 通信作者: 陈晨

Risk factors of recurrence after endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for gallbladder and choledocholithiasis

Leiming Wang1, Chen Chen1,(), Hui Ding1, Xiuling Yin1, Qilong Zhong1, Min Si1   

  1. 1. Department of General Surgery, Jiangsu Shuyang People’s Hospital, Suqian 223600, China
  • Received:2018-06-09 Published:2019-06-01
  • Corresponding author: Chen Chen
  • About author:
    Corresponding author: Chen Chen, Email:
引用本文:

王雷鸣, 陈晨, 丁辉, 殷秀玲, 仲启龙, 司敏. 经内镜逆行胰胆管造影联合腹腔镜胆囊切除术后胆囊结石合并胆总管结石复发的危险因素分析[J/OL]. 中华普通外科学文献(电子版), 2019, 13(03): 224-228.

Leiming Wang, Chen Chen, Hui Ding, Xiuling Yin, Qilong Zhong, Min Si. Risk factors of recurrence after endoscopic retrograde cholangiopancreatography combined with laparoscopic cholecystectomy for gallbladder and choledocholithiasis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(03): 224-228.

目的

探讨经内镜逆行胰胆管造影(ERCP)联合腹腔镜胆囊切除术(LC)治疗胆囊结石合并胆总管结石复发的危险因素。

方法

回顾性分析2012年1月至2015年3月沭阳县人民医院诊断为胆囊结石合并胆总管结石患者87例,均行ERCP联合LC术治疗。根据患者术后结石复发情况分为复发组与非复发组,对比两组患者一般情况、术者经验、胆道情况、结石情况。单因素分析以及多因素Logistic回归分析术后结石复发的危险因素。

结果

87例患者术后随访32~60个月,中位随访时间为48个月,未复发组66例,复发组21例,中位复发时间15.0(95% CI=12.5~20.0)个月,术后1、2、3年复发率分别为8.0%、23.0%、24.1%,复发主要集中于术后2年内。单因素分析显示,胆道感染、胆道狭窄、胆总管夹角、结石数量、结石大小、乳头旁憩室情况影响胆囊结石合并胆总管结石复发(均P<0.05)。多因素分析显示,胆总管夹角(OR=0.196,95% CI=0.044~0.877)、胆道感染(OR=6.894,95% CI=1.698~27.984)、乳头旁憩室(OR=10.554,95% CI=2.134~52.197)、胆道口括约肌切开(OR=17.803,95% CI=3.342~94.845)是胆囊并胆总管结石术后复发的独立危险因素。

结论

合并胆总管夹角过小、胆道感染、乳头旁憩室及术中括约肌切开的患者,ERCP联合LC术后结石更容易复发,对临床的预防和治疗有一定借鉴意义。

Objective

To explore the risk factors of recurrence of gallbladder and common bile duct stones by endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC).

Methods

From January 2012 to March 2015, eighty-seven cases with cholecystolithiasis complicated with choledocholithiasis diagnosed in Shuyang Peoples Hospital were analyzed retrospectively, all of whom were treated with ERCP combined with LC. Clinical data were collected and the patients were divided into recurrence group and non-recurrence group, according to recurrence of stones. Univariate factor analysis and multivariate Logistic regression analysis were performed to identify the risk factors forpostoperative stone recurrence.

Results

Sixty-six cases of non-recurrence group and twenty-one cases of recurrence group were followed up for 32-60 months with a median of 48 months. The median recurrence time was 15.0 months (95% CI=12.5-20.0). The recurrence rates were 8.0%, 23.0% and 24.1% at 1, 2, and 3 years after operation, respectively, the recurrence mainly occurred within 2 years after operation. Univariate analysis showed that biliary tract infection, biliary stricture, common bile duct angle, the number of stones, stone size, nipple diverticula affected the recurrence of cholecystolithiasis with common bile duct stones (all P<0.05). Multivariate analysis showed that common bile duct angle (OR=0.196, 95% CI=0.044-0.877), biliary tract infection (OR=6.894, 95% CI=1.698-27.984), peripapillary diverticulum (OR=10.554, 95% CI=2.134-52.197), and Oddi sphincterotomy (OR=17.803, 95% CI=3.342-94.845) were independent risk factors for recurrence of cholecystolithiasis after cholecystectomy.

Conclusions

Patients with small common bile duct angle, biliary tract infection, peripapillary diverticulum, and intraoperative oddi sphincterotomy are more likely to recur after ERCP combined with LC. It can be used for reference in further clinical prevention and treatment.

图1 经内镜逆行胰胆管造影联合腹腔镜胆囊切除术后结石复发情况病例分布直方图 核密度估计和正态(高期)估计的分布类似,数据分布较稳定
表1 影响经内镜逆行胰胆管造影联合腹腔镜胆囊切除术后结石复发的单因素分析(例)
表2 经内镜逆行胰胆管造影联合腹腔镜胆囊切除术后结石复发多因素Logistic回归分析
[1]
Mishra T, Lakshmi KK, Peddi KK. Prevalence of cholelithiasis and choledocholithiasis in morbidly obese south Indian patients and the further development of biliary calculus disease after sleeve gastrectomy, gastric bypass and mini gastric bypass[J]. Obes Surg, 2016, 26(10): 2411-2417.
[2]
李强, 汪志伟, 柴琛. 胆总管结石治疗方法的研究进展[J]. 胃肠病学和肝病学杂志, 2017, 26(12): 1436-1438.
[3]
梁廷波, 白雪莉, 陈伟. 腹腔镜胆总管探查术治疗胆总管结石的现状与进展[J]. 中华消化外科杂志, 2018, 17(1): 22-25.
[4]
Chen YY, Chen CC. Cholelithiasis[J]. N Engl J Med, 2017, 377(4): 371.
[5]
李振毅, 陶立. 胆总管结石取石术后结石复发的危险因素Logistic回归分析[J]. 中国现代医学杂志, 2016, 26(11): 122-126.
[6]
游勤建, 袁发秀, 宋平. 腹腔镜联合胆道镜与传统开腹手术治疗胆囊结石合并胆总管结石的疗效对比[J]. 河北医学, 2016, 22(5): 721-724.
[7]
王亮, 折占飞, 乔宇, 等. 腹腔镜联合胆道镜经胆囊管探查治疗胆囊结石合并胆总管结石[J]. 中国微创外科杂志, 2017, 17(2): 189-192.
[8]
Yan W, Zheng LL, Yu H, et al. An excerpt of BSG guidelines on the management of common bile duct stones(2017)[J]. J Clin Hepatol, 2017, 33(8): 1440-1447.
[9]
Lee R, Ha H, Han YS, et al. Predictive factors for long operative duration in patients undergoing laparoscopic cholecystectomy after endoscopic retrograde cholangiography for combined choledochocystolithiasis[J]. Surg Laparosc Endosc Percutan Tech, 2017, 27(6): 491-496.
[10]
Zhang JF, Du ZQ, Lu Q, et al. Risk factors associated with residual stones in common bile duct via T tube cholangiography after common bile duct exploration[J]. Medicine (Baltimore), 2015, 94(26): e1043.
[11]
张莉, 江堤, 苏剑东, 等. 胆道口括约肌功能障碍在胆囊切除术后再发胆总管结石发病机制中的作用[J/CD]. 中华普通外科学文献(电子版), 2016, 10(4): 298-300.

URL    
[12]
许旭, 张立广, 李全福, 等. 内镜保胆取石术后结石复发分析:720例保胆患者随访资料[J]. 腹腔镜外科杂志, 2017, 22(5): 349-351.
[13]
石玉琪, 许春芳. ERCP联合腹腔镜胆囊切除术治疗胆总管结石合并胆囊结石术后胆总管结石复发的危险因素分析[J]. 中华消化内镜杂志, 2016, 33(10): 689-692.
[14]
王瓯越. 肠胆反流与胆色素结石形成的关系[J]. 中国普通外科杂志, 2017, 26(8): 1057-1064.
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