Yoo Eun Soo, Yoo Byung Moo, Kim Jin Hong, Hwang Jae Chul, Yang Min Jae, Lee Kee Myung, Kim Soon Sun, Noh Choong Kyun
a Department of Gastroenterology , Ajou University School of Medicine , Suwon , South Korea.
Scand J Gastroenterol. 2018 Apr;53(4):466-470. doi: 10.1080/00365521.2018.1438507. Epub 2018 Feb 19.
Recurrence of primary common bile duct (CBD) stone commonly occurs after complete removal of CBD stones in patients with cholecystectomy. This study aimed to investigate potential risk factors for the recurrence of primary CBD stones after endoscopic treatment.
Between January 2005 and December 2015, the endoscopic retrograde cholangiopancreatography (ERCP) database of our medical center was retrospectively reviewed; information regarding eligible patients who had recurrent CBD stones with a history of previous cholecystectomy was collected. The characteristics of the patients, CBD stone, CBD and ERCP-related factors were analyzed.
The recurrence rate of CBD stone was 18.5% (115/622) after endoscopic treatment in patients with cholecystectomy. In univariate analysis, the number of CBD stones (≥2), CBD stone diameter (≥10 mm), stone composition, stone consistency, CBD diameter (≥15 mm), bile duct dilatation pattern, sharp bile duct angulation (<145°), balloon dilatation, large balloon (>12 mm) dilatation, endoscopic mechanical lithotripsy, endoscopic sphincterotomy, and endoscopic papillary balloon dilatation alone method were significant between the non-recurrence and recurrence groups. However, in multivariate analysis (based on the binary logistic regression method), the number of CBD stones (≥2) (adjusted odds ratio [AOR] 3.232; 95% confidence interval [CI] 1.344-7.773; p = .009), cholesterol stone (AOR 2.824; 95% CI 1.175-6.786; p =.02) and sharp bile duct angulation (<145°) (AOR 2.462; 95% CI 1.062-5.711; p = .036) were independent risk factors of CBD stone recurrence after cholecystectomy.
CBD stone number (≥2), cholesterol stone and sharp bile duct angulation (<145°) are associated with recurrent common bile duct stones after cholecystectomy.
在胆囊切除术患者中，原发性胆总管结石在结石完全清除后常复发。本研究旨在探讨内镜治疗后原发性胆总管结石复发的潜在危险因素。
回顾性分析2005年1月至2015年12月我院医疗中心的内镜逆行胰胆管造影（ERCP）数据库；收集有胆囊切除史且胆总管结石复发的符合条件患者的信息。分析患者、胆总管结石、胆总管及ERCP相关因素的特征。
胆囊切除术患者内镜治疗后胆总管结石复发率为18.5%（115/622）。单因素分析显示，胆总管结石数量（≥2个）、结石直径（≥10毫米）、结石成分、结石质地、胆总管直径（≥15毫米）、胆管扩张模式、胆管锐角（<145°）、球囊扩张、大球囊（>12毫米）扩张、内镜机械碎石、内镜括约肌切开术以及单纯内镜乳头球囊扩张术在未复发组和复发组之间存在显著差异。然而，多因素分析（基于二元逻辑回归方法）显示，胆总管结石数量（≥2个）（调整优势比[AOR] 3.232；95%置信区间[CI] 1.344 - 7.773；p = 0.009）、胆固醇结石（AOR 2.824；95% CI 1.175 - 6.786；p = 0.02）和胆管锐角（<145°）（AOR 2.462；95% CI 1.062 - 5.711；p = 0.036）是胆囊切除术后胆总管结石复发的独立危险因素。
胆总管结石数量（≥2个）、胆固醇结石和胆管锐角（<145°）与胆囊切除术后胆总管结石复发有关。
