胆总管结石术后复发风险因素

Risk factors for postoperative recurrence of choledocholithiasis

目的:寻找胆总管结石术后复发的风险因素,指导胆总管结石的治疗.方法:回顾性分析唐山市工人医院肝胆外科2002-01/2007-01共收治的523例胆总管结石患者的临床资料,采用COX比例风险模型分别对患者性别、年龄、手术方法、是否存在十二指肠憩室等8种可能影响胆总管结石复发的因素进行单因素及多因素分析.结果:患者术后3、5、10年的累积结石复发率别为6.5%,9.5%和15.1%.患者的性别、年龄、胆总管结石数目以及是否存在胆囊结石4种因素对胆总管结石手术后复发的影响无统计学意义;罹患十二指肠乳头旁憩室的患者术后再次发生胆总管结石的风险比是无憩室患者的1.37倍(95%CI:1.02-4.04,P<0.05);胆总管直径≥15 mm的患者术后胆总管结石复发的风险比是<15 mm患者的2.16倍(95%CI:1.12-5.08,P<0.01);接受内镜下十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)治疗的患者术后结石复发的风险比是接受传统手术患者的2.20倍(95%CI:1.13-6.87,P<0.05).结论:罹患十二指肠乳头旁憩室或者胆总管扩张或者接受过EST治疗的患者,再次复发胆总管结石的风险显著增加.

AIM： To idenfiy the risk factors for postoperative recurrence of choledocholithiasis to guide the therapy of this disease.METHODS： In this retrospective study, 523 patients with choledocholithiasis who were admitted to our department from January 2002 to January 2007 were reviewed retrospectively. Factors that may influence postoperative choledocholithiasis recurrence were analyzed using the Cox＇s proportional hazards regression model. RESULTS： The cumulative incidence of choledocholithiasis recurrence was 6.5% at 3 years, 9.5% at 5 years and 15.1% at 10 years after surgery. The postoperative recurrence did not significantly relate to the patient＇s gender, age, the number of stones, and the presence of cholecystolithiasis or not. The recurrence risk in cases with juxtapapillary duodenal diverticulum was 1.37 times as much as those without diverticulum （95%CI： 1.02-4.04, P 〈 0.05）; the recurrence risk of cases with the common bile duct ≥ 15 mm in diameter was 2.16 times of those with a common bile duct diameter 〈 15 mm （95%CI： 1.12-5.08, P 〈 0.01）. The recurrence risk in patients receiving endoscopic sphincterotomy （EST） was 2.2 times than those receiving traditional operations （95%CI： 1.13-6.87, P 〈 0.05）. CONCLUSION＂ Juxtapapillary duodenal diverticulum, common bile duct 〉 15 mm in diameter and EST could significantly increase the risk of postoperative choledocholithiasis recurrence.