Ando T, Tsuyuguchi T, Okugawa T, Saito M, Ishihara T, Yamaguchi T, Saisho H
First Department of Medicine, Chiba University School of Medicine, Chiba, Japan.
Gut. 2003 Jan;52(1):116-21. doi: 10.1136/gut.52.1.116.
The long term outcome of endoscopic papillotomy (EPT) is not well known. The aims of this study were to clarify the clinical course of post-EPT patients and to detect predictors for bile duct stone recurrence.
A total of 1042 consecutive patients who underwent EPT for bile duct stones from December 1975 to September 1998 were prospectively followed up. Patients were divided into four groups according to gall bladder (GB) status: "acalculous GB" group, "calculous GB" group, "cholecystectomy" group, and "prior cholecystectomy" group. Reliable follow up information was obtained for 983 (94.3%) of the 1042 patients. The following factors were considered in the evaluation of predisposing risk factors for recurrence of bile duct stones: age, sex, gall bladder status, periampullary diverticulum, number of bile duct stones, diameter of bile duct stones, diameter of bile duct, lithotripsy, precutting, pneumobilia, and early complications.
Recurrence occurred in 111 patients. The "acalculous GB" group was less prone to recurrence than the "prior cholecystectomy" group and the "calculous GB" group. The relative risks (RR) for the latter two compared with the former group were 2.26 (95% confidence interval (CI) 1.24-4.14; p=0.0078) and 2.16 (95% CI 1.21-3.87; p=0.0093), respectively. Other prognostic factors were lithotripsy (RR 2.37; 95% CI 1.47-3.81; p=0.0004) and pneumobilia (RR 1.57; 95% CI 1.01-2.43; p=0.044).
Gall bladder status, lithotripsy, and pneumobilia were significantly related to bile duct stone recurrence after EPT.
内镜乳头切开术（EPT）的长期疗效尚不清楚。本研究的目的是阐明EPT术后患者的临床病程，并检测胆管结石复发的预测因素。
对1975年12月至1998年9月期间连续接受EPT治疗胆管结石的1042例患者进行前瞻性随访。根据胆囊（GB）状态将患者分为四组：“无结石胆囊”组、“有结石胆囊”组、“胆囊切除术”组和“既往胆囊切除术”组。1042例患者中有983例（94.3%）获得了可靠的随访信息。在评估胆管结石复发的易感危险因素时考虑了以下因素：年龄、性别、胆囊状态、壶腹周围憩室、胆管结石数量、胆管结石直径、胆管直径、碎石术、预切开、气肿性胆囊炎和早期并发症。
111例患者出现复发。“无结石胆囊”组比“既往胆囊切除术”组和“有结石胆囊”组更不易复发。后两组与前一组相比的相对风险（RR）分别为2.26（95%置信区间（CI）1.24-4.14；p=0.0078）和2.16（95%CI 1.21-3.87；p=0.0093）。其他预后因素为碎石术（RR 2.37；95%CI 1.47-3.81；p=0.0004）和气肿性胆囊炎（RR 1.57；95%CI 1.01-2.43；p=0.044）。
胆囊状态、碎石术和气肿性胆囊炎与EPT术后胆管结石复发显著相关。
