Bandirma Onyedi Eylül University Faculty of Medicine, Department of General Surgery, Balikesir, Turkey.
Medicine (Baltimore). 2022 Mar 4;101(9):e29037. doi: 10.1097/MD.0000000000029037.
Recurrent stone detection is common after endoscopic treatment of common bile duct stones (CBDS). This study aimed to identify the risk factors for recurrence of CBDS.We retrospectively evaluated 14 patients who underwent endoscopic treatment for CBDS. Risk factors for single and multiple recurrent CBDSs were evaluated using logistic regression analysis.Endoscopic and needle-knife precut sphincterotomy was performed in 506 and 112 patients, respectively. There was 1 recurrence in 85 patients (13.8%), 2 recurrences in 23 patients (3.7%), and 3 recurrences in 9 patients (1.5%). According to the multivariate analyses, being older than 65 years (odds ratio [OR] 1.084, P = .000), concomitant heart disease (OR 2.528, P = .002), concomitant lung disease (OR 1.766, P = .035), a large common bile duct diameter (OR 1.347, P = .000), presence of cholelithiasis (OR 1.752, P = .018), stent (OR 1.794, P = .023), or T-tube placement in the common bile duct (OR 47.385, P = .000), and prolongation of the procedure (OR 1.037, P = .000) increased the risk of recurrence, while having undergone cholecystectomy due to gallstones (OR 1.645, P = .042). The mean stone diameter (P = .059), nitroglycerin use (P = .129), and periampullary diverticulum (P = .891) did not increase the risk of recurrent CBDS.The probability of multiple recurrences after the first recurrence of CBDS increased with age >65 years, concomitant heart/lung diseases, stent/T-tube placement in the common bile duct, a wide common bile duct (≥10 mm), and cholelithiasis.
经内镜治疗胆总管结石 (CBDS) 后,常可检测到结石复发。本研究旨在确定 CBDS 复发的危险因素。我们回顾性评估了 14 例行内镜治疗 CBDS 的患者。使用逻辑回归分析评估了单发和多发 CBDS 复发的危险因素。506 例患者行内镜下括约肌切开术,112 例患者行经皮经肝胆囊穿刺引流术。85 例患者中有 1 例复发(13.8%),23 例患者有 2 次复发(3.7%),9 例患者有 3 次复发(1.5%)。多变量分析显示,年龄大于 65 岁(比值比 [OR] 1.084,P = 0.000)、合并心脏病(OR 2.528,P = 0.002)、合并肺病(OR 1.766,P = 0.035)、胆总管直径较大(OR 1.347,P = 0.000)、存在胆石症(OR 1.752,P = 0.018)、支架(OR 1.794,P = 0.023)或 T 管置入胆总管(OR 47.385,P = 0.000)、操作时间延长(OR 1.037,P = 0.000)会增加复发风险,而因胆囊结石行胆囊切除术(OR 1.645,P = 0.042)会降低复发风险。结石平均直径(P = 0.059)、硝酸甘油使用(P = 0.129)和壶腹周围憩室(P = 0.891)均不会增加 CBDS 复发的风险。CBDS 首次复发后,多次复发的概率随着年龄>65 岁、合并心脏病/肺病、支架/T 管置入胆总管、胆总管增宽(≥10mm)和胆石症而增加。