胆石成分和脂质代谢指标对胆总管结石ERCP术后结石复发的影响

Gallstone composition and lipid metabolism can influence the recurrence of common bile duct calculi after ERCP

目的探究胆结石成分脂质代谢指标对胆总管结石经内镜逆行胰胆管造影术(ERCP)术后的影响,并明确其对术后复发的意义。方法选取北京友谊医院2018年3月~2020年11月住院的进行经内镜逆行性胰胆管造影术的患者92例。所有患者均按照是否在术后6个月后出现结石复发,分为复发组和非复发组。检测并对比分析患者的胆总管结石成分、脂代谢指标水平。结果经统计,复发31例,复发率33.7%,未复发61例(66.3%)。两组一般资料比较,差异无统计学意义(P>0.05)。两组患者中均有一定例数分布在胆固醇、胆色素、混合型中,进一步组间比较,复发组以混合型结石的占比48.4%最高,未复发组则以胆固醇结石的占比63.9%最高,组间比较,复发组混合型结石占比48.4%显著高于未复发组。经检测,复发组脂质代谢指标的总体水平显著高于未复发组,差异有统计学意义(P<0.05);进一步对各组内不同结石成分分析,两组患者中,均以混合型结石的各脂质代谢指标水平较其他2种类型的代谢指标水平高(TC、LDL除外),差异有统计学意义(P<0.05);而复发组的各类型结石的脂质代谢指标水平(HDL除外)显著高于未复发组的水平,而其HDL低于未复发组,差异有统计学意义(P<0.05)。结论ERCP术后出现结石复发的患者存在明显的脂质代谢紊乱情况,且以混合型结石占比较高,而未复发组的结石占比仍以胆固醇结石占比较多。在临床患者术后结石预防中,脂质代谢紊乱仍是结石预防的重点。

Objective To explore the effect of lipid metabolism indexes of gallstone components on postoperative choledocholithiasis after ERCP,and to clarify its significance for postoperative recurrence.Methods Patients admitted to our hospital from March 2018 to November 2020 for retrograde endoscopic cholangiography were selected as the subjects of this study.According to the inclusion and exclusion criteria,92 patients who met the criteria were selected as the subjects of this study.All patients were divided into two groups according to whether recurrence of calculi occurred 6 months after surgery,recurrence group and non-recurrence group.Detection and comparative analysis the level of choledocholithiasis components and lipid metabolism indexes in patients.Results The recurrence rate was 33.7%in 31 cases and no recurrence in 61 cases(66.3%).There was no significant difference in general data between the two groups(P>0.05).A certain number of patients in both groups were distributed in cholesterol,bile pigment and mixed type.Further comparison between the two groups showed that the proportion of mixed type stones in the recurrence group was 48.4%,and that of cholesterol stones in the non-recurrence group was 63.9%.Comparison between the two groups showed that the proportion of mixed type stones in the recurrence group was 48.4%,which was significantly higher than that in the non-recurrence group.The overall level of lipid metabolism indexes in recurrence group was significantly higher than that in non-recurrence group(P<0.05).Further analysis of different calculus components in each group showed that in both groups,the lipid metabolism indexes of mixed calculus were higher than those of the other two types(except TC、LDL),P<0.05.The levels of lipid metabolism indexes(except HDL)in the recurrence group were significantly higher than those in the non-recurrence group,while the HDL was lower than that in the non-recurrence group,P<0.05.Conclusion Patients with recurrence of calculi after ERCP have obvious disorders of lipid metabolism,and the proportion of mixed calculi is relatively high,while the proportion of cholesterol calculi is still relatively high in the non-recurrence group.In the prevention of postoperative stone in clinical patients,the disorder of lipid metabolism is still the focus of stone prevention.