Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
Surg Endosc. 2021 Dec;35(12):6497-6504. doi: 10.1007/s00464-020-08143-w. Epub 2020 Nov 17.
Common bile duct (CBD) stone recurrence is considered an unresolved concern after cholecystectomy and complete extraction of previous CBD stones. This study aimed to investigate the potential risk factors for primary CBD stone recurrence after cholecystectomy and endoscopic treatment.
The endoscopic retrograde cholangiopancreatography (ERCP) database of our medical center was retrospectively reviewed between February 2008 and May 2018. A total of 45 patients with CBD stone recurrence with a history of previous cholecystectomy were recruited in the study. Moreover, 104 patients who underwent cholecystectomy at our medical center and who were followed up for more than 1 year without CBD stone recurrence were assigned to the control group. The characteristics of the patients, surgical records during cholecystectomy, and ERCP records obtained immediately before cholecystectomy were analyzed.
Univariate analysis, based on the binary logistic regression method, indicated that age (p = 0.01) and the presence of the periampullary diverticulum (PAD; p = 0.006) were significantly different between the non-recurrence and recurrence groups. However, the surgical records during cholecystectomy were not significantly different between the two groups. The CBD stone number (p = 0.039), CBD stone diameter (≥ 10 mm; p = 0.05), and CBD diameter (≥ 15 mm; p < 0.001), based on the ERCP findings were significantly different between the two groups. Multivariate analysis revealed that CBD diameter (≥ 15 mm; OR, 3.878; 95% CI, 1.406-10.697; p = 0.008) was the independent risk factors for CBD stone recurrence after cholecystectomy.
CBD diameter (≥ 15 mm) at the time of the initial ERCP is associated with CBD stone recurrence after cholecystectomy.
胆总管（CBD）结石复发被认为是胆囊切除术后和先前 CBD 结石完全取出后的一个未解决的问题。本研究旨在探讨胆囊切除术后和内镜治疗后原发性 CBD 结石复发的潜在危险因素。
回顾性分析 2008 年 2 月至 2018 年 5 月我院内镜逆行胰胆管造影（ERCP）数据库。共纳入 45 例既往胆囊切除术后 CBD 结石复发患者。此外，将我院胆囊切除术且随访超过 1 年无 CBD 结石复发的 104 例患者纳入对照组。分析患者特征、胆囊切除术期间的手术记录以及胆囊切除术前即刻获得的 ERCP 记录。
基于二元逻辑回归方法的单变量分析表明，年龄（p = 0.01）和壶腹周围憩室（PAD；p = 0.006）在未复发组和复发组之间存在显著差异。然而，两组之间的胆囊切除术记录无显著差异。根据 ERCP 结果，CBD 结石数量（p = 0.039）、CBD 结石直径（≥10mm；p = 0.05）和 CBD 直径（≥15mm；p < 0.001）在两组之间存在显著差异。多变量分析显示，CBD 直径（≥15mm；OR，3.878；95%CI，1.406-10.697；p = 0.008）是胆囊切除术后 CBD 结石复发的独立危险因素。
初始 ERCP 时 CBD 直径（≥15mm）与胆囊切除术后 CBD 结石复发相关。
