既往胆囊切除术后患者胆总管结石的危险因素:一项多中心前瞻性概念验证研究。
Risk Factors for Common Bile Duct Stones in Patients with Previous Cholecystectomy: A Multicenter Prospective Proof-of-Concept Study.
作者信息
Lisotti Andrea, Togliani Thomas, Masciangelo Graziella, Bruni Angelo, Rakichevikj Emilija, Vilmann Peter, Mirante Vincenzo Giorgio, Fusaroli Pietro
机构信息
Gastroenterology Unit, Hospital of Imola, University of Bologna, 40026 Imola, Italy.
Gastroenterology and Digestive Endoscopy Unit, University Hospital Borgo Trento, 37126 Verona, Italy.
出版信息
J Clin Med. 2025 Jun 26;14(13):4532. doi: 10.3390/jcm14134532.
Most studies assess risk factors for common bile duct (CBD) stones in patients with gallbladder in situ. We aimed to assess risk factors for CBD stones in patients with previous cholecystectomy in a proof-of-concept study. We enrolled consecutive patients undergoing EUS for suspected symptomatic CBD stones and recorded demographic variables, clinical presentation, liver function tests (LFTs), and transabdominal ultrasound (US) findings. EUS was used as gold standard for CBD stones. Multivariate analysis was used to identify risk factors in the training set; a model was created and tested on the validation set. A total of 211 patients (25.6% male; median age, 66 [49-75] years old) were enrolled; 77.7% presented with abdominal pain, 30.3% with hyperbilirubinemia, 26.5% with pancreatitis, and 61.1% with LFT alterations. Ultrasound showed CBD dilation in 37.4% patients. Overall, 96 (45.5%) patients had CBD stones. According to multivariate analysis, male gender (OR 2.54 [1.26-5.09]; = 0.009), age > 63 years (OR 3.06 [1.63-5.72]; < 0.001), LFT alteration (OR 2.62 [1.40-4.91]; = 0.003), and CBD dilation (OR 2.46 [1.31-4.65]; = 0.005) were independently related to CBD stones. A model was created based on the number of risk factors on admission; patients with no risk factor had a 9.5% prevalence of CBD stones; those with one risk factor, 26.7%; two risk factors, 53.2%; three risk factors, 66.7%; and four risk factors, 100%. The results of this proof-of-concept study identify male gender, age, LFT alteration, and CBD dilation as risk factors for CBD stones in patients with previous cholecystectomy. An adequate assessment of the pre-test probability will guide patients' subsequent management.
大多数研究评估的是原位胆囊患者胆总管(CBD)结石的危险因素。在一项概念验证研究中,我们旨在评估既往行胆囊切除术患者发生CBD结石的危险因素。我们纳入了因疑似有症状的CBD结石而接受超声内镜检查(EUS)的连续患者,并记录了人口统计学变量、临床表现、肝功能检查(LFTs)和经腹超声(US)检查结果。EUS被用作CBD结石的金标准。采用多变量分析来确定训练集中的危险因素;创建一个模型并在验证集中进行测试。共纳入211例患者(男性占25.6%;中位年龄66[49 - 75]岁);77.7%的患者有腹痛症状,30.3%有高胆红素血症,26.5%有胰腺炎,61.1%有LFT改变。超声检查显示37.4%的患者CBD扩张。总体而言,96例(45.5%)患者有CBD结石。根据多变量分析,男性(比值比[OR]2.54[1.26 - 5.09];P = 0.009)、年龄>63岁(OR 3.06[1.63 - 5.72];P < 0.001)、LFT改变(OR 2.62[1.40 - 4.91];P = 0.003)和CBD扩张(OR 2.46[1.31 - 4.65];P = 0.005)与CBD结石独立相关。根据入院时危险因素的数量创建了一个模型;无危险因素的患者CBD结石患病率为9.5%;有一个危险因素的患者为26.7%;两个危险因素的患者为53.2%;三个危险因素的患者为66.7%;四个危险因素的患者为100%。这项概念验证研究的结果确定了男性、年龄、LFT改变和CBD扩张是既往行胆囊切除术患者发生CBD结石的危险因素。对检查前概率进行充分评估将指导患者的后续管理。