内镜治疗胆总管结石远期疗效观察及结石复发危险因素分析

目的 探讨内镜下十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)治疗胆总管结石患者的远期疗效,分析术后胆总管结石复发的危险因素.方法 收集2006年1月至12月因胆总管结石而行EST治疗患者154例,对患者的有关指标与术后胆总管结石复发的关系进行多因素分析.结果 出现远期并发症22例(14.29%),其中胆总管结石复发18例(11.69%),16例伴发胆管炎;单纯胆管炎1例(0.65%);急性胰腺炎2例(1.30%);胆管癌1例(0.65%).胆总管结石复发的危险因素有高体重指数和血清胆固醇水平;而十二指肠乳头中小切口(0.5 cm～1.5 cm)是胆总管结石复发的保护因素.结论 体重指数、血清胆固醇水平、十二指肠乳头切口大小与EST术后胆总管结石复发相关.

Long-term efficacy of endoscopic sphincterotomy in treatment of choledocholithiasis and the risk factors for recurrence

Objective To estimate the long-term efficacy of endoscopic sphincterotomy (EST)in treatment of choledocholithiasis and to analyze the potential risk factors for disease recurrence.Methods A total of 154 patients with choledocholithiasis,who underwent EST between January 2006and December 2006, were enrolled. Multivariate analysis was used to evaluate the association of clinical features and experimental parameters with recurrence of choledocholithiasis. Results Longterm complications developed in 22 patients (14.29%) including recurrent choledocholithiasis (18/154,11.69 % ) and combined cholangitis (16/154). Cholangitis without calculi was found in 1 case (0.65%), acute pancreatitis in 2 cases (1.30%) and cholangiocarcinoma in 1 case (0.65%). High body mass index and serum cholesterol were proved to be risk factors for recurrence of choledocholithiasis. Whereas the incision size (0.5 cm-1.5 cm) of vater's papilla was the protective factor for recurrence of choledocholithiasis. Conclusions Body mass index, serum cholesterol and the incision size of vater's papilla are related to recurrence of choledocholithiasis.