CAJ | 학술논문

目的探讨不同的常用内镜治疗方法对胆总管结石青年患者治疗后结石复发的影响以及结石近期复发、远期复发的危险因素.方法选择经一次性治疗性内镜逆行胰胆管术(ERCP)成功取石后随访资料完整的胆总管结石青年(21 ～45岁)患者,按手术方式分为内镜下乳头球囊扩张术(EPBD)组、乳头括约肌切开术(EST)组、EST(切开＜0.5 cm)+EPBD组,进行随访,统计近期(≤3年)及远期(＞3年)结石复发率,并对复发危险因素进行Logistic回归分析.结果资料完整的327例患者平均随访76.5个月,54例(16.5％)结石复发,其中近期复发35例(10.7％),远期复发19例(5.8％).近期胆总管结石复发率EPBD组(11.3％)和EST组(13.2％)均高于EST+ EPBD组(8.1％),但无统计学差异(P均＞0.05).远期胆总管结石复发率EPBD组(11.3％)和EST组(6.6％)均显著高于EST+ EPBD组(0.8％),差异具统计学意义(P均＜0.05).Logistic回归分析结果表明,胆囊结石、结石最大径、结石个数、机械碎石与近期结石复发显著相关(P＜0.05),而远期胆总管结石复发则与结石最大径及单纯球囊扩张显著相关(P＜0.05).结论对于胆总管结石青年患者,单纯EPBD取石固然可保留乳头括约肌功能,但增加了结石的远期复发风险,而乳头括约肌小切开联合EPBD取石可显著降低胆总管结石复发率.
목적 탐토불동적상용내경치료방법대담총관결석청년환자치료후결석복발적영향이급결석근기복발、원기복발적위험인소.방법 선택경일차성치료성내경역행이담관술(ERCP)성공취석후수방자료완정적담총관결석청년(21 ～45세)환자,안수술방식분위내경하유두구낭확장술(EPBD)조、유두괄약기절개술(EST)조、EST(절개＜0.5 cm)+EPBD조,진행수방,통계근기(≤3년)급원기(＞3년)결석복발솔,병대복발위험인소진행Logistic회귀분석.결과 자료완정적327례환자평균수방76.5개월,54례(16.5％)결석복발,기중근기복발35례(10.7％),원기복발19례(5.8％).근기담총관결석복발솔EPBD조(11.3％)화EST조(13.2％)균고우EST+ EPBD조(8.1％),단무통계학차이(P균＞0.05).원기담총관결석복발솔EPBD조(11.3％)화EST조(6.6％)균현저고우EST+ EPBD조(0.8％),차이구통계학의의(P균＜0.05).Logistic회귀분석결과표명,담낭결석、결석최대경、결석개수、궤계쇄석여근기결석복발현저상관(P＜0.05),이원기담총관결석복발칙여결석최대경급단순구낭확장현저상관(P＜0.05).결론 대우담총관결석청년환자,단순EPBD취석고연가보류유두괄약기공능,단증가료결석적원기복발풍험,이유두괄약기소절개연합EPBD취석가현저강저담총관결석복발솔.
Objective To investigate the rate of stone recurrence in young patients with common bile duct (CBD) stones after removal of stones by different endoscopic strategies and the risk factors of recent and long-term CBD stone recurrence.Methods After successful CBD stones removal in one ERCP session,young patients (aging 21-45 years) with complete follow-up data were recruited to the study.They were divided into endoscopic papillary balloon dilation (EPBD) group,endoscopic sphincterotomy (EST) group and EST + EPBD group according to the endoscopic approaches they experienced.The recent (≤3 years) and long-term (＞3 years) recurrent frequencies of CBD stone were counted,and the possible risk factors were determined with multivariate logistic regression analysis.Results A total of 327 young patients were followed up at a mean duration of 76.5 months,and CBD stone re-occurred in 54 cases (16.5％.),among which,the recent recurrence was 35 cases (10.7％) and the long-term recurrence was 19 cases (5.8％).The recent CBD stone recurrence rates in EPBD group and the EST group were higher than that of EST + EPBD group but with no significant difference (P all ＞ 0.05).The long-term CBD stone recurrence rates in EPBD group and the EST group were significantly higher than that of the EST + EPBD group (P all ＜ 0.05).Logistic regression analysis showed that,gallbladder stone,the maximum diameter of the stone,the stone number and mechanical lithotripsy were significantly related to the recent CBD stone recurrence (P ＜ 0.05).The long-term CBD stone recurrence was significantly related to the maximum diameter of the stone and balloon dilatation alone (P ＜ 0.05).Conclusion Removal of CBD stones by EPBD alone for young patients may preserve the papillary sphincter function,but would increase the risk of long-term CBD stone recurrence.Small endoscopic sphincterotomy plus EPBD could significantly reduce the CBD stone recurrence rate.