胆囊切除对内镜下逆行胰胆管造影术后胆管炎复发的预防

目的探讨胆管结石合并胆管炎经内镜下逆行胰胆管造影术（ERCP）清除结石后，行胆囊切除术对减少胆管炎复发的作用。 方法选择2010年1月至2017年10月间宝鸡市人民医院收治的1 000例胆管结石合并胆管炎患者，并分为对照组502例（常规ERCP清除胆管结石）和胆囊切除组498例（在上述治疗基础上给予开腹或腹腔镜胆囊切除术）。回顾性分析两组患者的基本临床资料、结石情况及胆管炎复发率，采用Kaplan-Meier法分析累积复发率及胆管炎相关不良事件发生率，胆管炎复发的影响因素先进行单因素分析再进行非条件多因素Logistic回归分析。 结果两组患者基础资料比较差异无统计学意义。术后胆管炎复发277例，包括对照组175例（34.9%），胆囊切除组102例（20.5%）。胆囊切除组患者的胆管炎复发率及胆管炎相关不良事件发生率显著低于对照组，差异有统计学意义（χ²=2.031、5.035，P=0.034、0.001）。单因素分析和Logistic回归分析结果显示，年龄、结石数量、结石最大直径、胆总管扩张、术后并发症以及是否行胆囊切除术是胆管炎复发的独立因素（均P<0.05）。 结论经ERCP清除胆管结石后行胆囊切除术能够显著降低胆管结石合并胆管炎患者的胆管炎复发率，值得临床关注。

Prevention of recurrence of cholangitis after endoscopic retrograde cholangiopancreatography bycholecystectomy

ObjectiveTo investigate the effect of cholecystectomy on reducing the recurrence of cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis and cholangitis. MethodsA retrospective analysis of one thousand cases with cholelithiasis and cholangitis admitted in Shaanxi Baoji People's Hospital from January 2010 to October 2017 was carried out. They were divided into control group (502 cases, conventional removal of bile duct stone with ERCP) and cholecystectomy group (498 cases, open or laparoscopic cholecystectomy based on the above treatment). The basic clinical data, stone situation and the recurrence of cholangitis were compared between the two groups. Cumulative relapse rate and incidence of adverse events related to cholangitis were analyzed by Kaplan-Meier method. The factors influencing recurrence of cholangitis were analyzed by univariate factor analysis and unconditional multivariate Logistic regression analysis. ResultsThere were no significant differences in basic clinical data between the two groups. Postoperative cholangitis recurred in 277 cases, including 175 cases (34.9%) in the control group, and 102 cases (20.5%) in the cholecystectomy group. The recurrence rate of cholangitis and the incidence of adverse events related to cholangitis in the cholecystectomy group were significantly lower than those in the control group (χ²=2.031, 5.035; P=0.034, 0.001). Univariate analysis and Logistic regression analysis showed that age, number of stones, maximum diameter of stones, dilatation of common bile duct, postoperative complications and cholecystectomy were independent factors for the recurrence of cholangitis (all P<0.05). ConclusionCholecystectomy after removal of cholelithiasis by ERCP can significantly reduce the recurrence rate of cholangitis in patients with cholelithiasis and cholangitis.