胆囊结石合并隐匿性胆总管结石的高危因素分析

The risk factors of gallbladder stones with occult choledocholithiasis based on routine preoperative examinations

目的结合患者术前的常规检查结果,探讨胆囊结石合并有隐匿性胆总管结石的高危因素。方法选取2017年2月~2021年6月安徽省太和县人民医院80例住院患者,术前彩超检查均提示胆囊结石,进一步以MRCP检查有无隐匿性胆总管结石分为两组:合并胆总管结石的为研究组40例及无胆总管结石对照组40例患者。收集患者住院期间的病历资料。采用卡方检验比较两组患者病历资料的差异。将有统计学差异的因素再纳入Logistics回归模型中进行多因素分析探讨影响胆囊结石合并隐匿性胆总管结石的因素。结果临床资料单因素分析显示研究组存在临床症状、谷丙转氨酶(ALT)升高、白细胞计数(WBC)升高、多发胆结石和胆总管直径增粗的比例显著高于对照组,差异有统计学意义。然而,其余变量的差异无统计学意义,包括性别、年龄、术前谷草转氨酶(AST)、总胆红素(TB)、碱性磷酸酶(ALP)以及谷氨酰转肽酶(GGT)。多因素logistics回归分析显示多发胆囊结石和胆总管增粗是胆结石伴隐性胆总管结石的高危因素。结论多发胆囊结石及胆总管增粗是胆囊结石合并隐匿性胆总管结石的高危因素。如果超声提示多发胆囊结石或者合并胆总管增粗,特别合并ALT升高,应高度怀疑合并隐匿性胆总管,建议进一步检查。

Objective To investigate the risk factors of gallbladder stones with occult choledocholithiasis based on routine preoperative examinations.Methods From February 2017 to June 2021,80 patients with gallbladder stones diagnosed by ultrasound in Taihe County People’s Hospital of Anhui Province were selected and further divided into two groups,40 patients with occult choledocholithiasis as research group,40 patients without it as control group.Clinical data of each patient during the hospitalization were collected.Then,the Chi-square test was performed to compare clinical data between the two groups.All Statistically significant variables were included in the logistics regression model to analyze the risk factors of gallbladder stones with choledocholithiasis.Results Univariate analysis of clinical data showed that the rate of clinical symptoms,alanine transaminase(ALT)elevation,white blood cell count(WBC)elevation,multiple gallstones and common bile duct diameter thickening in the research group was higher than that in the control group,and the difference was statistically significant.However,the rest variables between the two groups were not statistically significant differences,including gender,age,preoperative serum aspartate transaminase(AST),total bilirubin(TB),alkaline phosphatase(ALP)and glutamyl transpeptidase(GGT).Multivariate logistics regression analysis showed that multiple gallstones and common bile duct diameter are independent influencing factors of gallstones with occult choledocholithiasis.Conclusion If patient with gallbladder stones has multiple stones or thickening of the common bile duct,it should be highly suspected that there may be occult choledocholithiasis,and further examination is suggested to confirm diagnosis before surgery.