内镜治疗胆总管结石复发的危险因素分析及对策

Risk factors and countermeasures for recurrence of common bile duct stones after endoscopictreatment

目的:探讨胆总管结石经内镜治疗后复发的危险因素及预防措施.方法:选取2008-01/2012-05于我院行内镜下治疗胆总管结石的患者进行随访和调研,745例患者获得完整随访资料,其中有64例(8.59%)患者复发胆总管结石,采用单因素及多因素非条件Logistic回归分析方法进行危险因素的研究,并根据发病因素探讨预防措施.结果:统计学结果显示壶腹周围憩室(B=0.582,OR=1.790)、前期胆囊切除(B=1.012,O R=2.751)、胆囊结石未治疗(B=0.744,OR=2.103)、胆总管直径(B=1.062,OR=2.892)、胆总管结石直径(B=0.536,O R=1.708)、胆道积气(B=1.034,OR=2.812)、机械碎石(B=0.828,OR=2.289)是胆总管结石内镜治疗后复发的危险因素(B>0,OR>1);正常胆囊(B=-0.889,P=0.410)是结石复发的保护因素(B<0,OR<1).结论:内镜治疗胆总管结石后复发与患者自身因素及内镜医师的操作相关,可以通过细化操作步骤等措施有效减少和/或预防胆总管结石的复发.

AIM： To investigate the risk factors and preven- tive measures for recurrence of common bile duct stones after endoscopic treatment. METHODS： Patients who underwent endoscopic treatment for common bile duct stones between January 2008 and May 2012 at our hospital were screened, and 745 patients with complete follow- up data were identified, of whom 64 （8.59%） had recurrent choledocholithiasis. Univariate and multivariate Logistic regression analyses were used to analyze the risk factors for recurrence of common bile duct stones, and preventive mea-sures based on these risk factors were explored. RESULTS： Periampullary diverticulum （B = 0.582, OR =1.790）, pre-cholecystectomy （B = 1.012, OR = 2.751）, gallstones untreated （B= 0.744, OR = 2.103）, common bile duct diameter （B =1.062, OR = 2.892）, diameter of common bile duct stones （B = 0.536, OR = 1.708）, biliary gas retention （B = 1.034, OR=2.812）, and mechanical lithotripsy （B = 0.828, OR = 2.289） were risk fac- tors for common bile duct stone recurrence after endoscopic treatment （B 〉 0, OR 〉1）; normal gallbladder （B =0.889, P = 0.410） was a protec- tive factor （B 〈 0, OR 〈 1）. CONCLUSION： Recurrence of common bile duct stones after endoscopic treatment is associated with the patient＇s own factors and endoscopic manipulations. The relapse of common bile duct stones can be effectively reduced and/or pre- vented by improving endoscopic manipulations.