胆总管结石十二指肠镜治疗后复发因素研究

Risk factors of recurrent common bile duct stones after ERCP

目的 探讨胆总管结石经ERCP治疗后复发的相关因素.方法 选择资料完整经ERCP治疗的胆总管结石患者,共802例,其中297例伴胆囊结石,222例胆囊已切除,283例胆囊无结石,统计复发频度并对复发因素进行单变量和多变量logistic回归分析.结果 802例患者平均随访84.8个月,92例（11.5%）结石复发.胆囊结石,胆总管直径≥1.5 cm,机械碎石及胆管角度≤120°在单因素及多因素分析中均显示为复发因素;胆固醇结石,乳头狭窄或Oddi括约肌功能障碍在多因素分析中为复发因素;胆囊切除,毕Ⅱ式胃大部切除,结石≥1.5 cm及多发结石在单因素分析中为复发因素.结论 ERCP治疗胆总管结石的病例中胆囊结石,胆总管直径≥1.5 cm,机械碎石及胆管角度≤120°可能为主要的复发因素;胆囊切除,毕Ⅱ式胃大部切除,乳头狭窄或Oddi括约肌功能障碍,结石≥1.5 cm,胆固醇结石及多发结石也是复发相关因素.

Objective To investigate the risk factors of recurrent common bile duct （CBD） stones after treatment with endoscopic retrograde cholangiopancreatography （ERCP）. Methods A total of 802 patients with CBD stone and with complete follow-up data were recruited to the study, among which 297 patients were accompanied with gallstone, 222 patients having undergone cholecystectomy before ERCP and 283 having no gallstones. The CBD stone recurrent frequency and the possible risk factors were calculated with uni- and multi-variate logistic regression analysis. Results The patients were followed up at a mean duration of 84. 8 months, and CBD stone re-occurred in 92 （11.5%）. Both uni- and multivariate analysis showed gallstones, CBD larger than 1.5 cm, endoscopic mechanical lithotrity （EML） and angle of bile duct less than 120° were risk factors of recurrence. Multivariate analysis showed cholesterol stones, cholangeal stricture or sphincter of Oddis dysfunction （SOD） were all risk factors for reccurrence. Univariate analysis revealed that history of cholecystectomy or Billroth Ⅱ gastrectomy, stones larger than 1.5 cm and multiple stones were risk factors of recurrence. Conclusion For those with CBD stones undergoing ERCP, gallstone,common bile larger than 1. 5cm, EML and the angle of CBD less than 120° are major risk factors of recurrence. History of cholecystectomy and Billroth Ⅱ gastrectomy, SOD, large CBD stone （ ≥1.5 cm）, cholesterol stone and multiple stones are also associating risk factors.