ERCP和EST治疗胆总管结石复发危险因素分析

Analysis of risk factors for stone recurrence in patients with common bile duct stones after ERCP and EST therapy

目的分析影响胆总管结石患者行逆行胰胆管造影(ERCP)和内镜下乳头括约肌切开取石术(EST)治疗后结石复发的危险因素。方法我院诊治的胆总管结石患者357例,常规行ERCP检查,发现胆管内有结石后行EST。对结石直径<1.0 cm者,用取石网篮取石;对结石直径≥1.0 cm者,用碎石篮碎石取出;对巨大结石,于胆管内置入支架,再择期取石。采用Logistic回归分析影响治疗后结石复发的危险因素。结果在357例患者,行ERCP插管成功349例(97.8%),行EST取石成功334例(93.6%),其中一次取石成功者297例(88.9%),两次取石成功者37例(11.1%);随访发现结石复发138例,未复发219例;单因素分析结果显示,复发组病程、年龄和乳头切口分别为(10.9±2.5)年、(66.8±7.2)岁和(15.6±1.9) mm,显著长于或大于未复发组【分别为(7.6±1.7)年、(57.3±8.7)岁和(7.9±2.2) mm,P均<0.05】,复发组有胆道手术史、乳头旁憩室、胆道狭窄、合并胆管或胰腺炎、结石数量≥2枚和结石直径≥10 mm比率分别为18.8%、29.7%、30.4%、78.9%、81.9%和40.6%,显著高于未复发组的1.8%、7.3%、11.4%、40.6%、64.8%和9.6%(P均<0.05);进一步行Logistic回归分析显示,胆总管直径≥10 mm和乳头切口≥15mm为患者术后结石复发的独立危险因素。结论对于乳头切口和胆总管直径较大的患者,临床应该警惕其术后结石复发,增加随访次数,以早期发现。

Objective To analyze the risk factors for stone recurrence in patients with common bile duct stones after endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphineterotomy (EST) therapy. Methods 357 patients with common bile duct stones were recruited in our hospital,and routine ERCP examination were done. The stone were removed by EST. All patients were followed-up and routine imaging examination were carried out to find the stone recurrence. The risk factors of stone recurrence after ERCP and EST treatment were evaluated by Logistic analysis. Results Out of the 357 patients,ERCP were successfully performed in 349(97.8%) patients,and the stones were successfully removed in 334(93.6%) patients;138 patients were found to have,and 219 have not stone recurrence during the followed-up period;univariate Logistic analysis showed that there were no significant differences in gender,BMI,and presence or absence of gallstones between patients with and without stone recurrence(P>0.05),while there were significant differences as respect to the course of disease,age and incision size between patients with recurrent stone and those without [(10.9±2.5) yr vs.(7.6±1.7) yr,(66.8±7.2) years old vs.(57.3±8.7) years old,and (15.6±1.9) mm vs.(7.9±2.2) mm,P<0.05];the percentages of biliary surgery history,diverticulum,biliary stricture,biliary or pancreatic inflammation,stone numbers more than 2 and stone diameters greater than 10 mm in patients with stone recurrence were 18.8%,29.7%,30.4%,78.9%,81.9%,and 40.6%,significantly higher than 1.8%,7.3%,11.4%,40.6%,64.8%,and 9.6% in patients without stone recurrence(P<0.05);multivariate Logistic regression analysis showed that the diameter of common bile duct greater than 10 mm and incision size greater than 15 mm were the independent factors for stone recurrence after operation. Conclusion Patients with larger papillary incision and dilated diameters of common bile duct might have stone recurrence after ERCP and EST operation,and they must be followed-up for early diagnosis.