CAJ | 학술논문

目的探讨经内镜逆行胰胆管术(ERCP)取石后胆总管结石复发的相关危险因素.方法对2009年ERCP取石的患者,随访观察术后胆总管结石复发情况.对比复发与未复发患者的性别、年龄、体重指数、初次病程、胆道手术史、胆囊结石、乳头旁憩室、胆总管直径、结石数量、结石大小、胆道狭窄11个相关因素,并对各相关因素行多因素Logistic回归分析,筛选出ERCP术后胆总管结石复发的主要危险因素.结果共成功随访190例患者,随访时间平均2.3年,结果胆总管结石复发68例,未复发122例.对比分析显示,胆总管结石复发组与未复发组的患者年龄[(65.5±l5.5)岁比(57.6±15.4)岁,P =0.001],初次病程(P=0.015),胆道手术史(17.6％比2.5％,P=0.000),憩室(29.4％比7.4％,P=0.000),胆总管直径[(15.0 ±5.1)mm比(10.7 ±3.4)mm,P=0.001],胆道狭窄(32.3％比13.9％,P=0.000),结石数量≥2(80.9％比72.9％,P=0.000),结石直径≥10 mm(35.3％比8.2％,P=0.000)为结石复发的危险因素.多因素分析显示,患者高龄(OR =3.44,95％ CI:1.55 ～7.63,P=0.002),有胆道手术史(OR=5.82,95％ CI:1.34 ～ 25.29,P=0.019),合并乳头旁憩室(OR=3.29,95％ CI:1.18 ～9.12,P=0.022),胆总管直径≥10 mm(OR=4.30,95％ CI:1.72 ～ 10.72,P=0.002),结石数量≥2(OR =4.24,95％ CI:1.61 ～ 11.16,P=0.003)为胆总管结石复发的独立危险因素.结论高龄、有胆道手术史、合并乳头旁憩室、胆总管直径≥10 mm、结石数量≥2为胆总管结石复发的独立危险因素.
목적 탐토경내경역행이담관술(ERCP)취석후담총관결석복발적상관위험인소.방법 대2009년ERCP취석적환자,수방관찰술후담총관결석복발정황.대비복발여미복발환자적성별、년령、체중지수、초차병정、담도수술사、담낭결석、유두방게실、담총관직경、결석수량、결석대소、담도협착11개상관인소,병대각상관인소행다인소Logistic회귀분석,사선출ERCP술후담총관결석복발적주요위험인소.결과 공성공수방190례환자,수방시간평균2.3년,결과담총관결석복발68례,미복발122례.대비분석현시,담총관결석복발조여미복발조적환자년령[(65.5±l5.5)세비(57.6±15.4)세,P =0.001],초차병정(P=0.015),담도수술사(17.6％비2.5％,P=0.000),게실(29.4％비7.4％,P=0.000),담총관직경[(15.0 ±5.1)mm비(10.7 ±3.4)mm,P=0.001],담도협착(32.3％비13.9％,P=0.000),결석수량≥2(80.9％비72.9％,P=0.000),결석직경≥10 mm(35.3％비8.2％,P=0.000)위결석복발적위험인소.다인소분석현시,환자고령(OR =3.44,95％ CI:1.55 ～7.63,P=0.002),유담도수술사(OR=5.82,95％ CI:1.34 ～ 25.29,P=0.019),합병유두방게실(OR=3.29,95％ CI:1.18 ～9.12,P=0.022),담총관직경≥10 mm(OR=4.30,95％ CI:1.72 ～ 10.72,P=0.002),결석수량≥2(OR =4.24,95％ CI:1.61 ～ 11.16,P=0.003)위담총관결석복발적독립위험인소.결론 고령、유담도수술사、합병유두방게실、담총관직경≥10 mm、결석수량≥2위담총관결석복발적독립위험인소.
Objective To reveal the related risk factors of recurrent common bile duct (CBD)stones after ERCP.Methods Collected the patients data who underwent ERCP from January 2009 to December 2009 for CBD stones.The factors including gender,age,body mass index (BMI),initial course of disease,history of biliary tract surgery,gallstones,papillary diverticulum,diameter of CBD,number of stones,size of stone and biliary stricture were compared between patients with recurrent CBD stone (recurrent group) or without (control group) by comparative analysis and multivariate logistic regression analysis.Results A total of 190 patients were followed up with a mean duration of 2.3 years,with 68 patients in recurrent group and 122 in control.The comparative analysis showed that age (65.5 ± 15.5 yr vs.57.6 ±15.4 yr,P =0.001),initial course of disease (P =0.015),history of biliary tract surgery (17.6％ vs.2.5％,P =0.000),papillary diverticulum (29.4％ vs.7.4％,P =0.000),diameter of CBD (15.0 ±5.1 mm vs.10.7 ±3.4 mm,P =0.001),number of stones≥2 (80.9％ vs.72.9％,P =0.000),diameter ofstone≥10mm (35.3％ vs.8.2％,P=0.000) and biliary stricture (32.3％ vs.13.9％,P=0.000)were statistically different between 2 groups.Multivariate analysis showed an older age (OR =3.44,95％ CI:1.55-7.63,P =0.002),previous biliary surgery (OR =5.82,95 ％ CI:1.34-25.29,P =0.019),having papillary diverticulum (OR =3.29,95％CI:1.18-9.12,P =0.022),diameter of CBD≥10 mm (OR =4.30,95％ CI:1.72-10.72,P =0.002),number of stones ≥2 (OR =4.24,95％ CI:1.61-11.16,P =0.003) are independent risk factors for recurrence of CBD stones.Conclusion An older age,previous biliary surgery history,papillary diverticulum,diameter of CBD ≥ 10 mm and number of stones ≥2 are independent risk factors for recurrence of CBD stones.