上海地区胆囊结石复发的多因素分析

Multifactorial analysis of the recurrence of cholecystolithiasis in Shanghai area

目的探讨胆囊结石复发的危险因素,寻找预防胆囊结石复发的可行方法。方法对上海地区采用保留胆囊(体外冲击波碎石、经皮胆镜碎石取石、口服药物溶石)方法治疗的、且胆囊结石已完全消失的1058例病人进行多因素分析,对122例病人随机检测血清胰岛素值和总胆汁酸值。结果经1年～8年8个月随访,胆囊结石消失后复发率分别为1年11.6%、2年22.4%、3年29.5%、4年36.4%、5年39.3%、5年以上39.7%。复发组病人的危险因素为:(1)多发结石(P<0.05);(2)有胆囊结石家族史(P<0.05);(3)喜食油腻食物(P<0.05);(4)平均血清胰岛素值低(P<0.01);(5)平均血清总胆汁酸值高(P<0.01)。结论胆囊结石的复发与高脂、高胆固醇食物的过多摄入有关,与胰岛素量的相对不足可能也有一定关系。

Objective To find the risk factors of the recurrence of cholecystolithiasis and the way to prevent the re- currence of gallstones.Methods A multifactorial analysis was performed for 1058 patients whose gallbladder stones had disappeared after different kinds of nonsurgical therapy,including oral litholytic therapy,extracorpore- al shock wave lithotripsy and percutaneous choledocholithotripsy in Shanghai area.Serum level of insulin and total bile acid were determined in 122 patients.Results After 1～8.8 years of follow-up,the recurrence rate of gallbladder stone was 11.6%、22.4%、29.5%、36.4%、39.3% and 39.7% respectively within 1、2、3、4、5 and over 5 years.The risk factors of the recurrence are:(1)primary multiple gallstones(P<0.05).(2)family history of choleeystolithiasis(P<0.05).(3)hobby of greasy food(P<0.01).(4)low mean value of serum insulin(P<0.01).(5)high mean value of total bile acid(P<0.01).Conclusion Content and hobby of di- et,overintake or low consumption of high fat and cholesterol food,relative deficiency of serum insulin may be re- lated to the recurrence of cholecystolithiasis.