| 胡 松,房姝妍,靳广甫,李 涵,杨 光,夏 辉,牟春露.胆总管结石取石术后复发的临床特征及其危险因素分析[J].,2017,17(22):4299-4302 |
| 胆总管结石取石术后复发的临床特征及其危险因素分析 |
| Analysis of Clinical Features and Risk Factors of Recurrence after Choledocholithotomy |
| 投稿时间：2016-12-27 修订日期：2017-01-20 |
| DOI：10.13241/j.cnki.pmb.2017.22.023 |
| 中文关键词: 胆总管结石 取石术 复发 危险因素 |
| 英文关键词: Choledocholithiasis Lithotomy Recurrence Risk factors |
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| 中文摘要: |
| 摘要 目的：探讨胆总管结石取石术后复发的临床特征并分析其危险因素。方法：回顾性分析2005年1月~2016年7月在我院手术的胆总管结石患者730例的病例资料，其中接受开腹胆道探查取石术550例定义为开腹组，腹腔镜胆总管探查取石术（LCBDE）30例定义为LCBDE组，经内镜十二指肠乳头括约肌切开取石术（EST）150例定义为EST组，对比三组复发率；按照有无复发分为复发组（n=227）和未复发组（n=503），采用单因素和多因素Logistic回归分析复发患者的临床特征和危险因素。结果：EST组复发率为38.67%，显著高于LCBDE组的26.67%和开腹组的29.27%（P<0.05）；单因素分析结果为患者在年龄、HBV感染史、黄疸、总胆红素异常、乳头旁憩室、胆道感染、胆道狭窄、乳头狭窄、Oddis括约肌功能障碍、胆道手术史、胆囊切除、胆总管直径≥15 mm、胆管角≤120°、手术类型、结石数量≥2粒、结石直径≥10 mm、有无胆囊结石具有统计学差异（P<0.05）；Logistic多因素回归分析结果为患者的年龄、有乳头旁憩室、有胆道手术史、胆总管直径≥15 mm、结石数量≥2粒、手术类型为EST均是胆总管结石取石术后复发的独立危险因素（P<0.05）。结论：胆总管结石取石术后复发的危险因素较多，临床应当根据患者的结石大小、数量及患者体质等综合考虑手术方式，并加强预防措施，力求控制胆总管结石取石术后的复发。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the clinical features of recurrence after choledocholithotomy and to analyze the risk factors. Methods: The clinical data of 730 patients with choledocholithiasis who were treated in our hospital from January 2005 to July 2016 were analyzed retrospectively, 550 cases who were received choledocholithotomy were defined as laparotomy group, 30 cases with laparoscopic common bile duct exploration (LCBDE) were defined as the LCBDE group, and 150 cases with endoscopic sphincterotomy (EST) were defined as EST group. The recurrence rate of the three groups were compared. The patients of three groups were divided into recurrence group (n=227) and non recurrence group (n=503) according to the recurrent situation, then the clinical features and risk factors of recurrent patients were analyzed by univariate and multivariate Logistic regression analysis. Results: The recurrence rate of EST group was 38.67%, which was significantly higher than that of LCBDE group with 26.67% and the laparotomy group with 29.27%, and there was statistical difference (P<0.05). The results of univariate analysis showed that there were statistically significant differences in age,history of HBV infection, jaundice, abnormal total bilirubin, peripapillary diverticulum, biliary infection, biliary stricture, papillary stenosis, sphincter of Oddis dysfunction, history of biliary surgery, cholecystectomy, bile duct diameter ≥15 mm, bile duct angle ≤120°, operation type, stone quantity ≥2 grains, stone diameter ≥10 mm, with or without gallstones (P<0.05). The results of Logistic multivariate regression analysis showed that age, having peripapillary diverticulum, having history of biliary surgery, bile duct diameter ≥15 mm, stone quantity ≥2grains and EST operation type were the independent risk factors of the recurrence after choledocholithotomy(P<0.05). Conclusion: There are many risk factors of recurrence after choledocholithotomy, and operation method should be based on the size and the number of the stones, and the constitution of patients.Preventive measures should be strengthened to control the recurrence after choledocholithotomy. |
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