经十二指肠镜乳头括约肌切开取石术后胆总管结石复发危险因素分析

Risk factors for recurrent common bile duct stones after endoscopic sphincterotomy

目的：探讨经十二指肠镜乳头括约肌切开（ EST ）取石术后胆总管结石复发的危险因素。方法采用非条件Logistic回归对2004年1月至2013年12月间在淮北市人民医院住院治疗的胆总管结石经EST取石患者521例的临床资料进行回顾性分析。结果经过平均25.6个月（6～114个月）的随访发现521例EST取石术后胆总管结石复发患者共53例，结石复发率为10.17％。单因素Logistic回归分析显示机械碎石、乳头旁憩室、乳头狭窄、胆总管成角、经内镜逆行胰胆管造影（ ERCP）操作≥2次及胆囊结石等与胆总管结石复发有关；多因素Logistic回归分析显示机械碎石、乳头狭窄、胆总管成角、ERCP 操作≥2次及Ⅱ型乳头旁憩室与胆总管结石复发有关；而年龄、性别、慢性肝病史、胆囊切除术、胆总管直径、毕Ⅱ手术史、结石大小、结石单发或多发、胆管狭窄， EST术前急性胆管炎及胆源性胰腺炎等因素均与胆总管结石复发无关。结论 EST取石术后胆总管结石复发更常见于机械碎石、乳头狭窄、胆总管成角、ERCP操作≥2次及Ⅱ型乳头旁憩室患者，如何尽量减少ERCP操作次数及减少机械碎石从而预防结石复发是今后努力的方向。

Objective To investigate the risk factors for patients with recurrent common bile duct （CBD）stones after endoscopic sphincterotomy （EST）.Meth ods Clinical data of 521 patients with CBD stones who underwent EST in our hospital were analyzed retrospectively from January 2004 to December 2013 by Logistic regression.Results Patients underwent follow-up for a mean of 25.6 months（6-114 months）,53 patients with CBD stones recurred with the recurrent rate of 10.17%.Univariate Logistic regression revealed that endoscopic mechanical lithotripsy （EML）,peripapillary diverticula,papillary stenosis,an angulated CBD, Endoscopic Retrograde Cholangiopancreatography （ ERCP ） times≥2 and cholecystolithiasis were risk factors for reccurrence .Multivariate Logistic regression analysis showed EML ,papillary stenosis ,an angulated CBD , ERCP times≥2 and typeⅡperipapillary diverticula were risk factors for reccurrence .No correlation with recurrence was found in following factors including age ,gender,chronic liver conditions,cholecystectomy, CBD diameter,Billroth′sⅡgastrectomy,stone size and quantity,biliary stenosis,acute cholangitis and acute bile pancreatitis .Conclusions Risk factors are more common in EML ,papillary stenosis ,an angulated CBD , ERCP times≥2 and typeⅡperipapillary diverticula .How to decrease ERCP times and EML to prevent stone recurrence is our future target .