胆总管结石患者经内镜逆行胰胆管造影术治疗后复发相关危险因素分析

The risk factors for recurrence after treatment of ERCP in patients with common bile duct stones

目的探究胆总管结石(Commonbileductstones,CBDS)患者经内镜逆行胰胆管造影术(Endoscopic retrograde cholangiopancreatography,ERCP)治疗后出现复发的危险因素。方法选择自2015年4月到2018年2月在本院经ERCP治疗的CBDS患者163例,根据NIHSS评分,根据其治疗后是否复发,将其分为复发组(观察组47例)和未复发组(对照组116例)。跟踪随访并记录两组患者的年龄、性别、BMI、既往史、血脂情况、结石情况、胆道情况以及CBDS复发情况等,并经统计分析CBDS患者发生ERCP术后复发的相关影响因素。结果所有CBDS患者中发生术后复发占28.8%;年龄、性别、BMI、既往史、胆总管结石家族史、血脂情况均与术后结石复发无明显关系(P> 0. 05);结石形态、结石大小、发生胆道感染、有ERCP治疗史以及有胆囊切除史与术后结石复发明显相关(P <0. 05);结石数量、胆道有乳头旁憩室与术后结石复发无明显关系(P> 0. 05);结石呈混合状、结石大小>10 mm、胆道发生感染、有ERCP治疗史以及有胆囊切除史是其术后结石复发的独立危险因素(P <0. 05)。结论 CBDS患者经ERCP治疗后结石复发其结石形态、胆道感染以及ERCP治疗史等紧密关联,临床上需重点关注,以促进患者预后。

To investigate the risk factors for recurrence after treatment with endoscopic retrograde cholangiopancreatography(ERCP)in patients with common bile duct stones(CBDS).A total of 163 patients with CBDS who were treated with ERCP in our hospital from April 2015 to February 2018 were selected.According to the NIHSS score and whether they had relapsed after treatment,the patients were divided into relapsed group(n=47),and non-recurrent group(n=116).The two groups were followed-up and their age,gender,BMI,past history,lipid status,stone status,biliary tract status,and recurrence of CBDS were recorded.The relevant factors affecting the recurrence of CBDS were statistically analyzed.Among all patients with CBDS,postoperative recurrence was accounted for 28.8%.The age,gender,BMI,past history,family history of common bile duct stones,and lipid status were not significantly associated with postoperative recurrence(P>0.05).However,the size of stones,biliary tract infection,history of ERCP,and history of cholecystectomy were significantly associated with postoperative stone recurrence(P<0.05)but not the number of stones and biliary duct diverticulum(P>0.05).Mixed stone,stone size>10 mm,biliary tract infection,history of ERCP treatment,and history of cholecystectomy were independent risk factors for postoperative calculi recurrence(P<0.05).The recurrence of stones after CERP treatment in patients with CBDS is closely related to the shape of stones,history of biliary tract infections,and history of ERCP treatment.It is necessary to pay close attention to clinical manifestations to promote the prognosis of the patients.