胆总管结石术后复发危险因素的研究进展

doi:10.3877/cma.j.issn.1674-0793.2022.06.013

胆结石的发病率为5%~15%，其中5%~30%合并胆总管结石。随着医疗技术的发展和术后加速康复外科的需要，创伤更小、恢复更快的腹腔镜胆总管探查术和经内镜逆行胰胆管造影术正逐步取代开腹胆总管切开术，并成为目前治疗胆总管结石的主要手段。胆总管结石微创治疗的结石清除率可高达95%，然而其复发率却没有降低（4%~25%）。因此，探明胆总管结石术后复发的危险因素并降低复发率是目前胆胰外科的研究重点。本文通过查阅相关文献，从年龄与性别、遗传基因、生活方式和药物干预、胆道微环境紊乱、胆道解剖因素、手术治疗方式、结石复发次数等7个方面对胆总管结石复发的危险因素作一综述，以期为结石复发的预防和治疗提供新的方向。

关键词: 胆总管结石, 复发, 危险因素, 腹腔镜胆总管探查, 胰胆管造影术，内窥镜逆行

The incidence of cholelithiasis is 5%-15%, of which 5%-30% is combined with common bile duct stones (CBDS). With the development of medical technology and the need for enhanced recovery after surgery, laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography are gradually replacing open choledochotomy with less trauma and faster recovery, and becoming the main means for CBDS. The stone clearance rate of CBDS minimally invasive treatment can be as high as 95%, while the recurrence rate has not been decreased (4%-25%). Therefore, identifying the risk factors for recurrence after CBDS operation and reducing the recurrence rate is the focus of current research in biliary and pancreatic surgery. This article reviewes the risk factors of CBDS recurrence from seven aspects, including age, gender, genetics, lifestyle and drug intervention, biliary microenvironment disturbance, biliary anatomy factors, surgical treatment methods, and the number of stone recurrences, in order to provide better understanding of the recurrence of CBDS.

Key words: Common bile duct stones, Recurrence, Risk factors, Laparoscopic common bile duct exploration, Cholangiopancreatography, endoscopic retrograde

[1]	Lyu Y, Cheng Y, Wang B, et al. Comparison of the efficacy and safety of three endoscopic methods to manage large common bile duct stones: A systematic review and network meta-analysis[J]. J Laparoendosc Adv Surg Tech A, 2021, 31(4): 443-454.
[2]	Deng F, Zhou M, Liu PP, et al. Causes associated with recurrent choledocholithiasis following therapeutic endoscopic retrograde cholangiopancreatography: A large sample sized retrospective study[J]. World J Clin Cases, 2019, 7(9): 1028-1037.
[3]	Singh AN, Kilambi R. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis[J]. Surg Endosc, 2018, 32(9): 3763-3776.
[4]	Kim DI, Kim MH, Lee SK, et al. Risk factors for recurrence of primary bile duct stones after endoscopic biliary sphincterotomy[J]. Gastrointest Endosc, 2001, 54(1): 42-48.
[5]	Ando T, Tsuyuguchi T, Okugawa T, et al. Risk factors for recurrent bile duct stones after endoscopic papillotomy[J]. Gut, 2003, 52(1): 116-121.
[6]	Parra-Membrives P, Martínez-Baena D, Lorente-Herce JM, et al. Choledocholithiasis recurrence following laparoscopic common bile duct exploration[J]. Cir Esp (Engl Ed), 2019, 97(6): 336-342.
[7]	Katsika D, Grjibovski A, Einarsson C, et al. Genetic and environmental influences on symptomatic gallstone disease: A Swedish study of 43 141 twin pairs[J]. Hepatology, 2005, 41(5): 1138-1143.
[8]	Buch S, Schafmayer C, Völzke H, et al. A genome-wide association scan identifies the hepatic cholesterol transporter ABCG8 as a susceptibility factor for human gallstone disease[J]. Nat Genet, 2007, 39(8): 995-999.
[9]	Buch S, Schafmayer C, Völzke H, et al. Loci from a genome-wide analysis of bilirubin levels are associated with gallstone risk and composition[J]. Gastroenterology, 2010, 139(6): 1942-1951.
[10]	Rosmorduc O, Hermelin B, Boelle P Y, et al. ABCB4 gene mutation-associated cholelithiasis in adults[J]. Gastroenterology, 2003, 125(2): 452-459.
[11]	von Schönfels W, Buch S, Wölk M, et al. Recurrence of gallstones after cholecystectomy is associated with ABCG5/8 genotype[J]. J Gastroenterol, 2013, 48(3): 391-396.
[12]	Di Ciaula A, Garruti G, Frühbeck G, et al. The role of diet in the pathogenesis of cholesterol gallstones[J]. Curr Med Chem, 2019, 26(19): 3620-3638.
[13]	Tran ZV, Weltman A, Glass GV, et al. The effects of exercise on blood lipids and lipoproteins: A meta-analysis of studies[J]. Med Sci Sports Exerc, 1983, 15(5): 393-402.
[14]	Stokes CS, Gluud LL, Casper M, et al. Ursodeoxycholic acid and diets higher in fat prevent gallbladder stones during weight loss: A meta-analysis of randomized controlled trials[J]. Clin Gastroenterol Hepatol, 2014, 12(7): 1090-1100, e61.
[15]	Wang HH, Portincasa P, de Bari O, et al. Prevention of cholesterol gallstones by inhibiting hepatic biosynthesis and intestinal absorption of cholesterol[J]. Eur J Clin Invest, 2013, 43(4): 413-426.
[16]	Chen X, Yan XR, Zhang LP. Ursodeoxycholic acid after common bile duct stones removal for prevention of recurrence: A systematic review and meta-analysis of randomized controlled trials[J]. Medicine (Baltimore), 2018, 97(45): e13086.
[17]	Yamamoto R, Tazuma S, Kanno K, et al. Ursodeoxycholic acid after bile duct stone removal and risk factors for recurrence: A randomized trial[J]. J Hepatobiliary Pancreat Sci, 2016, 23(2): 132-136.
[18]	Muratori R, Mandolesi D, Pierantoni C, et al. Ductal stones recurrence after extracorporeal shock wave lithotripsy for difficult common bile duct stones: predictive factors[J]. Dig Liver Dis, 2017, 49(10): 1128-1132.
[19]	Fukuba N, Ishihara S, Sonoyama H, et al. Proton pump inhibitor is a risk factor for recurrence of common bile duct stones after endoscopic sphincterotomy-propensity score matching analysis[J]. Endosc Int Open, 2017, 5(4): E291-E296.
[20]	Ye C, Zhou W, Zhang H, et al. Alterations of the bile microbiome in recurrent common bile duct stone[J]. Biomed Res Int, 2020, 2020: 4637560.
[21]	Shen H, Ye F, Xie L, et al. Metagenomic sequencing of bile from gallstone patients to identify different microbial community patterns and novel biliary bacteria[J]. Sci Rep, 2015, 5: 17450.
[22]	Leung JW, Sung JY, Costerton JW. Bacteriological and electron microscopy examination of brown pigment stones[J]. J Clin Microbiol, 1989, 27(5): 915-921.
[23]	Leung JW, Yu AS. Hepatolithiasis and biliary parasites[J]. Baillieres Clin Gastroenterol, 1997, 11(4): 681-706.
[24]	Li X, Gao P. Hepatitis C virus infection increases risk of gallstone disease in elderly Chinese patients with chronic liver disease[J]. Sci Rep, 2018, 8(1): 4636.
[25]	Ueno N, Ozawa Y, Aizawa T. Prognostic factors for recurrence of bile duct stones after endoscopic treatment by sphincter dilation[J]. Gastrointest Endosc, 2003, 58(3): 336-340.
[26]	Pereira-Lima JC, Jakobs R, Winter UH, et al. Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms[J]. Gastrointest Endosc, 1998, 48(5): 457-464.
[27]	Park SY, Hong TH, Lee SK, et al. Recurrence of common bile duct stones following laparoscopic common bile duct exploration: A multicenter study[J]. J Hepatobiliary Pancreat Sci, 2019, 26(12): 578-582.
[28]	Song ME, Chung MJ, Lee DJ, et al. Cholecystectomy for prevention of recurrence after endoscopic clearance of bile duct stones in Korea[J]. Yonsei Med J, 2016, 57(1): 132-137.
[29]	Yoo ES, Yoo BM, Kim JH, et al. Evaluation of risk factors for recurrent primary common bile duct stone in patients with cholecystectomy[J]. Scand J Gastroenterol, 2018, 53(4): 466-470.
[30]	Jeon J, Lim SU, Park CH, et al. Restoration of common bile duct diameter within 2 weeks after endoscopic stone retraction is a preventive factor for stone recurrence[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(3): 251-256.
[31]	Murabayashi T, Kanno Y, Koshita S, et al. Long-term outcomes of endoscopic papillary large-balloon dilation for common bile duct stones[J]. Intern Med, 2020, 59(7): 891-899.
[32]	Keizman D, Shalom MI, Konikoff FM. An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction[J]. Surg Endosc, 2006, 20(10): 1594-1599.
[33]	Zhang R, Luo H, Pan Y, et al. Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination[J]. Gastrointest Endosc, 2015, 82(4): 660-665.
[34]	Lobo DN, Balfour TW, Iftikhar SY, et al. Periampullary diverticula and pancreaticobiliary disease[J]. Br J Surg, 1999, 86(5): 588-597.
[35]	Li X, Zhu K, Zhang L, et al. Periampullary diverticulum may be an important factor for the occurrence and recurrence of bile duct stones[J]. World J Surg, 2012, 36(11): 2666-2669.
[36]	Kato S, Chinen K, Shinoura S, et al. Predictors for bile duct stone recurrence after endoscopic extraction for naïve major duodenal papilla: A cohort study[J]. PLoS One, 2017, 12(7): e180536.
[37]	Skar V, Skar AG, Osnes M. The duodenal bacterial flora in the region of papilla of Vater in patients with and without duodenal diverticula[J]. Scand J Gastroenterol, 1989, 24(6): 649-656.
[38]	Kim CW, Chang JH, Kim JH, et al. Size and type of periampullary duodenal diverticula are associated with bile duct diameter and recurrence of bile duct stones[J]. J Gastroenterol Hepatol, 2013, 28(5): 893-898.
[39]	Sugiyama M, Atomi Y. Risk factors predictive of late complications after endoscopic sphincterotomy for bile duct stones: long-term (more than 10 years) follow-up study[J]. Am J Gastroenterol, 2002, 97(11): 2763-2767.
[40]	Bove A, Bongarzoni G, Palone G, et al. Why is there recurrence after transcystic laparoscopic bile duct clearance? Risk factor analysis[J]. Surg Endosc, 2009, 23(7): 1470-1475.
[41]	Endo R, Satoh A, Tanaka Y, et al. Saline solution irrigation of the bile duct after stone removal reduces the recurrence of common bile duct stones[J]. Tohoku J Exp Med, 2020, 250(3): 173-179.
[42]	中华医学会消化内镜分会ERCP学组，胡冰，麻树人, 等. 内镜下逆行胆胰管造影术(ERCP)诊治指南(2010版)[J]. 中国继续医学教育, 2010, 2(6): 1-20.
[43]	Yasuda I, Fujita N, Maguchi H, et al. Long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation for bile duct stones[J]. Gastrointest Endosc, 2010, 72(6): 1185-1191.
[44]	Doi S, Yasuda I, Mukai T, et al. Comparison of long-term outcomes after endoscopic sphincterotomy versus endoscopic papillary balloon dilation: A propensity score-based cohort analysis[J]. J Gastroenterol, 2013, 48(9): 1090-1096.
[45]	Kojima Y, Nakagawa H, Miyata A, et al. Long-term prognosis of bile duct stones: endoscopic papillary balloon dilatation versus endoscopic sphincterotomy[J]. Dig Endosc, 2010, 22(1): 21-24.
[46]	Tsujino T, Kawabe T, Komatsu Y, et al. Endoscopic papillary balloon dilation for bile duct stone: immediate and long-term outcomes in 1 000 patients[J]. Clin Gastroenterol Hepatol, 2007, 5(1): 130-137.
[47]	Mu H, Gao J, Kong Q, et al. Prognostic factors and postoperative recurrence of calculus following small-incision sphincterotomy with papillary balloon dilation for the treatment of intractable choledocholithiasis: A 72-month follow-up study[J]. Dig Dis Sci, 2015, 60(7): 2144-2149.
[48]	Li S, Su B, Chen P, et al. Risk factors for recurrence of common bile duct stones after endoscopic biliary sphincterotomy[J]. J Int Med Res, 2018, 46(7): 2595-2605.
[49]	Choi JH, Lee TY, Cheon YK. Effect of stent placement on stone recurrence and post-procedural cholangitis after endoscopic removal of common bile duct stones[J]. Korean J Intern Med, 2021, 36(Suppl 1): S27-S34.
[50]	Yang J, Peng JY, Pang EJ, et al. Efficacy of endoscopic nasobiliary drainage for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis and cholangitis after repeated clearance of common bile duct stones: experience from a Chinese center[J]. Dig Endosc, 2013, 25(4): 453-458.
[51]	Al-Habbal Y, Reid I, Tiang T, et al. Retrospective comparative analysis of choledochoscopic bile duct exploration versus ERCP for bile duct stones[J]. Sci Rep, 2020, 10(1): 14736.
[52]	Pan L, Chen M, Ji L, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: An up-to-date meta-analysis[J]. Ann Surg, 2018, 268(2): 247-253.
[53]	Park BK, Seo JH, Jeon HH, et al. A nationwide population-based study of common bile duct stone recurrence after endoscopic stone removal in Korea[J]. J Gastroenterol, 2018, 53(5): 670-678.
[54]	Chang JH, Kim TH, Kim CW, et al. Size of recurrent symptomatic common bile duct stones and factors related to recurrence[J]. Turk J Gastroenterol, 2014, 25(5): 518-523.

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Progress on risk factors for postoperative recurrence of common bile duct stones

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