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鼻胆管冲洗预防胆总管结石内镜取石术后复发的研究 被引量:16

Biliary tube irrigation after endoscopic retrograde cholangiopancreatography to prevent the recurrence in patients with choledocholithiasis
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摘要 目的 探讨鼻胆管冲洗(BTI)预防胆总管结石患者经内镜逆行胰胆管造影术(ERCP)取石后复发的有效性.方法 连续收集2008年1月至2010年1月我院肝胆外科收治的接受ERCP取石的胆总管结石患者142例,随机分为BTI组(n=71)和常规处理组(n=71),前者取石术后给予BTI,后者给予常规处理.对所有患者入院时相关临床资料进行收集,并对所有患者出院后24个月内胆总管结石复发情况进行随访(每2个月随访1次),依据是否发生胆总管结石复发将患者分为复发组和未复发组,并对两组相关资料进行统计学分析.结果 经随访后,复发组和未复发组患者分别为40例和102例.两组组间基线资料比较表明年龄、体质量指数、合并十二指肠乳头憩室人数、胆总管直径、接受BTI人数及结石数目差异有统计学意义(P<0.05);将上述6项指标引入多因素Logistic回归分析,结果显示胆总管直径增加[相对危险度(RR)=1.35,95%可信区间(CI):1.12 ~1.48,P<0.01]、合并十二指肠乳头盘憩室(RR=1.42,95% CI:1.26 ~ 1.61,P<0.01)、未接受BTI(RR=1.54,95%CI:1.31 ~1.77,P<0.01)及结石数目较多(RR=1.46,95% CI:1.35 ~ 1.57,P<0.01)是ERCP取石术后结石复发的独立危险因素;未接受BTI处理预测患者胆总管结石复发的受试者工作特征(ROC)曲线下面积为0.659(P <0.01,95% CI:0.613 ~0.693);Kaplan-Meier生存曲线提示常规处理组患者结石复发率增高(39.44%比16.90%,P<0.05).结论 胆总管结石患者经ERCP取石术后给予BTI处理可以降低结石复发率. Objective To determine the efficacy of biliary tube irrigation (BTI) after endoscopic retrograde cholangiopancreatography (ERCP) to prevent the recurrence in patients with choledocholithiasis.Methods The study included 142 patients with choledocholithiasis admitted to the department of hepatobiliary surgery from 2008.1 to 2010.1.Patients were divided into BTI group (n =71) and non-BTI group (n =71).The BTI after ERCP was executed in BTI group,while the usual management in non-BTI group.All the patients were followed up bimonthly in 24 months after discharge and the recurrent time of choledocholithiasis was documented.According to the follow-up results,the patients were assigned into recurrent group and non-recurrent group.Results After follow-up,there were 40 and 102 patients in the recurrent group and non-recurrent group respectively.As compared with non-recurrent group,the age,body mass index,number of patients with papillary diverticulum,diameter of common bile duct (CBD) and number of stones were increased,while the number of patients undergoing BTI were decreased,in recurrent group (all P 〈 0.01).The multiple logistic regression analysis demonstrated that the augmented diameter of CBD [relative risk(RR) =1.35,95% confidence interval (CI):1.12-1.48,P 〈0.01],with papillary diverticulum (RR =1.42,95% CI:1.26-1.61,P 〈 0.01),without BTI (RR =1.54,95% CI:1.31-1.77,P 〈 0.01) and increased number of stones (RR =1.46,95% CI:1.35-1.57,P 〈 0.01) were the independent risk factors of recurrence of common duct stone in patients with choledocholithiasis undergoing ERCP operation.The area under the ROC curve (AUC) of without-BTI to predict the recurrence of choledocholithiasis was 0.65 9 (P 〈 0.01,95% CI:0.613-0.693).The Kaplan-Meier survival curve showed that the recurrence of choledocholithiasis was enhanced in non-BTI group (39.44% vs.16.90%,P 〈0.05).Conclusion The BTI after ERCP operation could reduce the recurrence of common duct stone in patients with choledocholithiasis.
作者 江帆 孙权
出处 《中华实验外科杂志》 CAS CSCD 北大核心 2014年第2期422-424,F0004,共4页 Chinese Journal of Experimental Surgery
关键词 胆总管结石 胆管冲洗 复发 内镜逆行胰胆管造影术 Choledocholithiasis Biliary tube irrigation Recurrence Endoscopic retrograde cholangiopancreatography
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