ERCP取石术后胆总管结石复发的相关因素

FACTORS FOR RECURRENCE OF COMMON BILE DUCT STONES AFTER ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY

目的探讨经内镜逆行胰胆管造影术(ERCP)治疗胆总管结石术后影响结石复发的相关因素。方法收集经ERCP治疗并获得随访胆总管结石病人的临床资料,包括一般资料及并发疾病、ERCP操作及胆管相关信息、术后实验室及影像学检查等资料,利用Cox回归模型分析胆总管结石复发的相关危险因素。结果纳入869例病人,中位随访时间38个月(6~72个月)。其中复发92例,复发率10.59%,1、3、5年累积复发率分别为2.82%、10.23%、15.41%,平均复发时间65.44个月。多因素回归分析显示,胆总管直径>11 mm(HR=1.852,95%CI=1.045~3.282,P<0.05)、ERCP操作史(HR=2.519,95%CI=1.256~5.052,P<0.05)、ERCP前胆囊切除史(HR=2.949,95%CI=1.616~5.380,P<0.001)是胆总管结石复发的独立危险因素,ERCP后胆囊切除不是复发的危险因素(P>0.05)。结论胆总管扩张(直径>11 mm)、ERCP操作史、ERCP前胆囊切除史的病人胆总管结石易复发,ERCP后胆囊切除不增加结石复发风险。

Objective To investigate the factors for recurrence of common bile duct stones after endoscopic retrograde cholangiopancreatography(ERCP).Methods Clinical data were collected from the patients who underwent ERCP and received follow-up,including general information,concomitant diseases,details of ERCP and the biliary tract,and laboratory and radiological examinations after ERCP.A Cox regression analysis was used to identify the risk factors for the recurrence of common bile duct stones.Results A total of 869 patients were enrolled,with a median follow-up time of 38 months(6-72 months),among whom 92 experienced recurrence,resulting in a recurrence rate of 10.59%.The 1,3,and 5 year cumulative recurrence rates were 2.82%,10.23%,and 15.41%,respectively,and the mean time to recurrence was 65.44 months.The multivariate regression analysis showed that a common bile duct diameter of>11 mm(HR=1.852,95%CI=1.045-3.282,P<0.05),a previous history of ERCP(HR=2.519,95%CI=1.256-5.052,P<0.05),and a history of pre-ERCP cholecystectomy(HR=2.949,95%CI=1.616-5.380,P<0.001)were independent risk factors for recurrence of common bile duct stones,while post-ERCP cholecystectomy was not a risk factor(P>0.05).Conclusion Patients with common bile duct dilatation(with a diameter of>11 mm),a previous history of ERCP,and a history of pre-ERCP cholecystectomy tend to experience the recurrence of common bile duct stones,and post-ERCP cholecystectomy does not increase the risk of recurrence.