Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Institute of Biomedical Informatics, National Yang-Ming University, Taipei, 11221, Taiwan.
Surg Endosc. 2018 Apr;32(4):1793-1801. doi: 10.1007/s00464-017-5863-8. Epub 2017 Sep 15.
The aim of this study was to evaluate the benefits of cholecystectomy on mitigating recurrent biliary complications following endoscopic treatment of common bile duct stone.
We used the data from the Taiwan National Health Insurance Research Database to conduct a population-based cohort study. Among 925 patients who received endoscopic treatment for choledocholithiasis at the first admission from 2005 to 2012, 422 received subsequent cholecystectomy and 503 had gallbladder (GB) left in situ. After propensity score matching with 1:1 ratio, the cumulative incidence of recurrent biliary complication and overall survival was analyzed with Cox's proportional hazards model. The primary endpoint of this study is recurrent biliary complications, which require intervention.
After matching, 378 pairs of patients were identified with a median follow-up time of 53 (1-108) months. The recurrent rate of biliary complications was 8.20% in the cholecystectomy group and 24.87% in the GB in situ group (p < 0.001). In the multivariate Cox regression analysis, the only independent risk factor for recurrent biliary complications was GB left in situ (hazard ratio [HR] 3.55, 95% CI 2.36-5.33).
Cholecystectomy after endoscopic treatment of common bile duct stone reduced the prevalence of recurrent biliary complications.
本研究旨在评估胆囊切除术在缓解内镜治疗胆总管结石后复发性胆道并发症方面的益处。
我们使用台湾全民健康保险研究数据库的数据进行了一项基于人群的队列研究。在 2005 年至 2012 年首次入院接受内镜治疗胆总管结石的 925 例患者中，422 例随后接受了胆囊切除术，503 例保留了胆囊（GB）。在进行 1:1 比例的倾向评分匹配后，采用 Cox 比例风险模型分析复发性胆道并发症和总生存的累积发生率。本研究的主要终点是需要干预的复发性胆道并发症。
匹配后，共确定 378 对患者，中位随访时间为 53（1-108）个月。胆囊切除术组的胆道并发症复发率为 8.20%，GB 原位组为 24.87%（p<0.001）。在多变量 Cox 回归分析中，GB 原位是复发性胆道并发症的唯一独立危险因素（风险比 [HR] 3.55，95%CI 2.36-5.33）。
内镜治疗胆总管结石后行胆囊切除术可降低复发性胆道并发症的发生率。
