内镜逆行胰胆管造影术后胆总管结石复发及利胆药物预防效果分析

Analysis of the recurrence of common bile duct stones after endoscopic retrograde cholangiopancreatography and the preventive effect of cholagogic drugs

目的探讨利胆药物预防内镜逆行胰胆管造影(ERCP)术后胆总管结石复发的远期疗效。方法回顾性分析2017年接受ERCP胆总管取石术患者的临床资料,分析患者病例资料特点,包括患者年龄、初次ERCP和再次ERCP比例、是否留置支架、是否服用利胆药物、结石复发情况,分析结石复发与十二指肠乳头旁憩室的关系。入选胆总管结石复发高危人群,建议应用胆宁片24周以上,观察用药后患者结石复发情况。结果共911例胆总管结石患者在ERCP术后完成随访。其中男性457例、女性454例,中位年龄69岁。605例患者初次行ERCP术,306例患者既往行取石术或乳头切开术。术后留置胆道支架患者370例,其中初次ERCP患者301例,再次ERCP患者中有69例更换胆道支架。再次ERCP患者留置支架比例低于初次ERCP患者(22.5%vs 49.8%,P<0.0001)。初次ERCP患者中,253例有乳头旁憩室、176例结石复发,有憩室患者结石复发率高于无憩室患者(34.0%vs 25.6%,P<0.05)。分别有80例入选长程组(治疗24周以上)和短程组(治疗不足12周),长程组58例、短程组64例随访至用药24周或终点(结石复发或急性胆管炎发作),其中21例(17.2%)结石复发,包括长程组5例(8.6%)、短程组16例(25.0%,P<0.05)。结论胆总管结石患者多次ERCP治疗后,支架留置比例降低,十二指肠乳头旁憩室与结石复发有一定关系,胆宁片有助于降低结石复发率,但须坚持服用。

Objective To explore the long-term effect of the cholagogic drug in preventing the recurrence of common bile duct stones after endoscopic retrograde cholangiopancreatography(ERCP).Methods The clinical data of patients who underwent ERCP choledocholithotomy within 2017 were analyzed retrospectively,including the age,the proportion of first-time ERCP and repeated ERCP,whether the ERCP patients were treated with stents,whether the patients took cholagogic drugs,stone recurrence rate.The relationship between stone recurrence and duodenal papillary diverticulum was analyzed.The patients at high risk of recurrence were selected,and were advised to take Danning tablets above 24 weeks,and the recurrence of stones was observed.Results A total of 911 patients with common bile duct stones underwent ERCP,including 457 males and 454 females,with a median age of 69 years old.605 patients underwent ERCP for the first time,and 306 patients had undergone lithotomy or papillotomy before.370 patients received biliary stents,among whom,301 patients received the first-time ERCP,and the other 69patients were replaced previous biliary stents during the repeated ERCP(49.8%vs 22.5%,P<0.0001).Of the 605 patients received firsttime ERCP,253 cases had parapapillary diverticulum,and 176 cases had stone recurrence.The rate of stone recurrence in the patients with diverticulum was significantly higher than that in the patients without diverticulum(34.0%vs 25.6%,P<0.05).160 patients were enrolled into the treatment group and control group,with 80 patients in each group.58 patients in the treatment group(taking Danning tablets over 24 weeks)and 64 patients in the control group(taking Danning tablets shorter than 12 weeks)were followed up to 24 weeks or the end point of recurrence of stones or acute cholangitis occurance.A total of 21(17.2%)patients had stones recurrence,including 5(8.6%)patients in the treatment group,and 16(25.0%)in the control group(P<0.05).Conclusions After repeated ERCP treatment,the rate of biliary stent implantation in patients with common bile duct stones reduced,and duodenal papillary diverticulum is related to stone recurrence.Danning tablets and other cholagogic drugs can help reduce the recurrence rate of stones,but need to be taken over 24 weeks.