内镜治疗后胆总管结石多次复发危险因素的初步分析

Analysis on the risk factors of multiple recurrent common bile duct stones after endoscopic treatment

目的探讨内镜括约肌切开术（EST ）治疗胆总管结石的患者术后多次复发的危险因素。方法对2007年6月1日至2011年6月1日行 EST 胆总管取石的患者进行随访，共成功随访2738例患者，随访时间为3-7年，将其中24例首次 EST 术后结石复发2次及以上的患者作为多次复发组。在未复发患者中用随机数字表法选取100例作为对照组。采用 t 检验和卡方检验对比两组患者的临床资料，对相关因素行 Logistic 回归分析，分析多次复发的危险因素。结果对比分析显示，未复发组与多次复发组间乳头旁憩室、胆道手术史、水平位胆总管与水平线夹角（胆总管夹角）＜45°的发生率差异有统计学意义[17．0％（17／100）比41．7％（10／24）、13．0％（13／100）比45．8％（11／24）、2．0％（2／100）比20．8％（5／24），χ^2＝6．914、13．37、9．595，P 均＜0．01]。进一步行 Logistic 回归分析，乳头旁憩室（B ＝1．421，OR ＝4．142，P＝0．01），胆道手术史（B ＝1．612，OR ＝5．011，P ＝0．004），胆总管夹角＜45°（B ＝2．661，OR ＝14．31，P＝0．005）为多次复发的危险因素。结论乳头旁憩室、既往有胆道手术史及胆总管夹角＜45°为胆总管结石多次复发的独立危险因素。

Objective To investigate the risk factors of multiple recurrent bile duct stones in patients with common bile duct （CBD） stones and received endoscopic sphincterotomy （EST ） treatment . Methods From June 1st ,2007 to June 1st ,2011 ,the patients received EST treatment were followed up , the follow‐up time was three to seven years .A total of 2 738 patients were successfully followed up , including 24 patients with two or more than two times of recurrent bile stone after EST who were enrolled in multiple recurrence group .One hundred patients without recurrence were randomly selected by table of random number as control group .The clinical data of two groups were compared by t test or Chi‐square test .The factors were analyzed with multivariate Logistic regression analysis and try to find out the risk factors of multiple recurrence .Results The comparative analysis between two groups showed that the three factors of juxtapapillary duodenal diverticula [17 .0% （17/100 ） vs 41 .7% （10/24 ）] ,history of biliary tract surgery [13 .0% （13/100） vs 45 .8% （11/24）] and the angle enclosed between the horizontal portion of the CBD and the horizontal plane （angleofbile duct） less than 45° [2 .0% （2/100） vs 20 .8% （5/24）] were statistically significant （χ^2 = 6 .914 、13 .37 、9 .595 ,all P 〈 0 .01 ） . Furthermore , logistic regression analysis indicated that juxtapapillary duodenal diverticula （B = 1 .421 ,OR = 4 .142 ,P = 0 .01） , history of biliary tract surgery （B = 1 .612 ,OR = 5 .011 ,P= 0 .004） and the angle of bile ductless than 45° （B= 2 .661 ,OR= 14 .31 ,P= 0 .005） were risk factors of multiple recurrence .Conclusion Juxtapapillary duodenal diverticula , history of biliary tract surgery , and the angle of bile duct less than 45° are independent risk factors of multiple recurrence of CBD stones .