胆囊切除术降低了胆石性胆管炎患者经内镜逆行胰胆管造影术（ERCP）清除胆管结石后复发性胆管炎的发生率。

Cholecystectomy decreased the recurrent cholangitis after clearance of bile duct stones by ERCP in patients with gallstone-related cholangitis.

机构信息

Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology & Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

出版信息

J Chin Med Assoc. 2017 Nov;80(11):690-696. doi: 10.1016/j.jcma.2017.03.012. Epub 2017 Aug 10.

DOI:10.1016/j.jcma.2017.03.012

PMID:28803891

Abstract

BACKGROUND

This study assessed whether cholecystectomy can decrease recurrent cholangitis and all-cause mortality in patients who received endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and successful clearance of bile duct (BD) stones after gallstone-related cholangitis.

METHODS

We analyzed data from the National Health Insurance research database of Taiwan. Patients who had gallstone-related cholangitis and underwent successful endoscopic clearance of BD stones were eligible for enrollment. This population-based, propensity score (PS)-matched cohort study involved 2 cohorts; (1) patients who underwent cholecystectomy after ERCP with BD stone clearance as the study group; and (2) those who had no cholecystectomy after ERCP with BD stone clearance as the control group. The primary endpoint was recurrent cholangitis, and the secondary endpoint was all-cause mortality.

RESULTS

During a mean 5.7-year follow-up, the incidence rates of recurrent cholangitis were 20.47 per 1000 person-years in the cholecystectomy cohort, and 34.60 per 1000 person-years in the PS-matched control cohort. The risk of recurrent cholangitis was significantly lower in the cholecystectomy cohort than in the control cohort (HR, 0.62; 95% confidence interval [CI], 0.45-0.87; P = 0.006). The HR for all cause mortality among the cholecystectomy cohort was 0.70 (95% CI, 0.54-0.90; P = 0.006) compared with the control cohort.

CONCLUSION

Cholecystectomy decreased the recurrent cholangitis and all-cause mortality in patients with endoscopic sphincterotomy and successful clearance of BD stones after gallstone-related cholangitis.

摘要

背景

本研究评估了在胆石性胆管炎后接受内镜逆行胰胆管造影（ERCP）和括约肌切开术并成功清除胆管（BD）结石的患者中，胆囊切除术是否可以降低复发性胆管炎和全因死亡率。

方法

我们分析了来自中国台湾地区全民健康保险研究数据库的数据。符合纳入标准的患者为患有胆石性胆管炎并经内镜成功清除 BD 结石。这项基于人群的倾向评分（PS）匹配队列研究涉及两个队列；（1）ERCP 后行胆囊切除术且 BD 结石清除的患者为研究组；（2）ERCP 后未行胆囊切除术且 BD 结石清除的患者为对照组。主要终点是复发性胆管炎，次要终点是全因死亡率。

结果

在平均 5.7 年的随访期间，胆囊切除术组的复发性胆管炎发生率为每 1000 人年 20.47 例，而 PS 匹配对照组的发生率为每 1000 人年 34.60 例。胆囊切除术组的复发性胆管炎风险明显低于对照组（HR，0.62；95%置信区间[CI]，0.45-0.87；P=0.006）。与对照组相比，胆囊切除术组的全因死亡率 HR 为 0.70（95%CI，0.54-0.90；P=0.006）。