十二指肠-胆管反流率在复发性胆总管结石患者中增加：来自钡餐检查的证据。

Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination.

机构信息

School of Biomedical Engineering, Fourth Military Medical University, Xi'an, China; Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.

School of Biomedical Engineering, Fourth Military Medical University, Xi'an, China.

出版信息

Gastrointest Endosc. 2015 Oct;82(4):660-5. doi: 10.1016/j.gie.2015.03.1908. Epub 2015 May 5.

DOI:10.1016/j.gie.2015.03.1908

PMID:25952091

Abstract

BACKGROUND

Stone recurrence is a common late adverse event after ERCP in patients with common bile duct stones (CBDS). Duodenal-biliary reflux (DBR) is considered a major cause of CBDS recurrence. However, specific evidence is still lacking.

OBJECTIVE

To investigate the DBR rate in patients with recurrent CBDS after ERCP.

DESIGN

A prospective case-control study.

SETTING

A tertiary center.

PATIENTS

During follow-up, patients with a history of either recurrent CBDS (recurrence group) or nonrecurrent CBDS (control group) were invited to participate in the study. All patients had previously undergone successful CBDS removal by ERCP. Patients in the control group were matched with the recurrence group by age and gender in a 1:1 ratio. Patients with gallbladder stones, hepatolithiasis, remnant CBDS, CBD strictures, or stents were excluded.

INTERVENTIONS

Standard barium meal examination, MRCP, and enhanced abdominal CT.

MAIN OUTCOME MEASUREMENTS

DBR.

RESULTS

Thirty-two patients with a history of recurrent CBDS and 32 matched control subjects were enrolled. Baseline characteristics and parameters regarding the first ERCP were comparable between the 2 groups. The DBR rate was significantly higher in the recurrent than in the control group (68.8% vs 15.6%, P < .001). Multivariate analysis indicated that DBR (OR, 9.59; 95% CI, 2.65-34.76) and acute distal CBD angulation (OR, 5.48; 95% CI, 1.52-19.78) were independent factors associated with CBDS recurrence. DBR rates in patients with no, single, or multiple recurrences were 15.6%, 60.9%, and 88.9%, respectively (P < .001). Intrahepatic bile duct reflux was more common in patients with multiple recurrences.

LIMITATIONS

Small sample size.

CONCLUSIONS

DBR is correlated with CBDS recurrence in patients who had previously undergone ERCP. DBR and acute distal CBD angulation are 2 independent risk factors related to stone recurrence. (

CLINICAL TRIAL REGISTRATION NUMBER

NCT02329977.)

摘要

背景

胆总管结石（CBDS）患者内镜逆行胰胆管造影（ERCP）后结石复发是常见的晚期不良事件。十二指肠-胆管反流（DBR）被认为是 CBDS 复发的主要原因。然而，具体证据仍缺乏。

目的

探讨 ERCP 后 CBDS 复发患者的 DBR 发生率。

设计

前瞻性病例对照研究。

设置

三级中心。

患者

在随访过程中，邀请有 CBDS 复发史的患者（复发组）或无 CBDS 复发史的患者（对照组）参加研究。所有患者均曾通过 ERCP 成功取出 CBDS。对照组患者按年龄和性别与复发组 1:1 匹配。排除有胆囊结石、肝内胆管结石、残余 CBDS、CBD 狭窄或支架的患者。

干预

标准钡餐检查、磁共振胰胆管成像（MRCP）和增强腹部 CT。

主要观察指标

DBR。

结果

共纳入 32 例有 CBDS 复发史的患者和 32 例匹配的对照患者。两组患者的基线特征和首次 ERCP 参数无差异。复发组的 DBR 发生率明显高于对照组（68.8%比 15.6%，P<.001）。多变量分析表明，DBR（比值比，9.59；95%置信区间，2.65-34.76）和胆总管远端急性成角（比值比，5.48；95%置信区间，1.52-19.78）是 CBDS 复发的独立相关因素。无复发、单发复发和多发复发患者的 DBR 发生率分别为 15.6%、60.9%和 88.9%（P<.001）。多发复发患者更常见肝内胆管反流。