胆囊结石合并胆总管结石术后复发的危险因素分析

目的：探讨内镜手术治疗胆囊结石合并胆总管结石患者复发的相关影响因素。 方法：回顾性分析2010年1月—2012年12月应用内镜治疗胆囊结石合并胆总管结石99例患者（51例行腹腔镜下胆囊切除+胆总管切开取石术，48例行腹腔镜下胆囊切除+十二指肠镜乳头切开取石术）的临床与随访资料，对影响结石复发的相关因素行单因素与多因素分析。 结果：术后共19例患者复发，复发率为19.19%。单因素分析显示，术后结石复发与年龄、黄疸、胆管扩张、胆总管直径、结石最大直径、结石数目、胆管、胰腺炎症以及手术类型等因素有关（均P<0.05），Logistic多因素回归分析发现，年龄（OR=2.692，P=0.011）、胆总管直径（OR=2.249，P=0.022）、结石数量（OR=2.647，P=0.017）、结石最大直径（OR=2.348，P=0.009）、合并炎症（OR=2.801，P=0.013）、手术类型（OR=2.421，P=0.018）是结石复发的独立危险因素。 结论：内镜手术治疗胆囊结石合并胆总管结石术后结石复发受多种因素影响，应当根据具体情况采用有针对性措施降低复发率。

Analysis of risk factors for postoperative recurrence of gallbladder stones with common bile duct stones

Objective: To analyze the factors affecting stone recurrence in patients with gallbladder stones and concomitant common bile duct stones after endoscopic treatment. Methods: The clinical and follow-up data of 99 patients with gallbladder stones and concomitant common bile duct stones undergoing endoscopic treatment(51 cases undergoing laparoscopic cholecystectomy plus common bile duct exploration and 48 cases undergoing laparoscopic cholecystectomy plus endoscopic sphincterotomy) from January 2010 to December 2012 were retrospectively analyzed. The related factors affecting stone recurrence were determined by univariate and multivariate analysis. Results: Stone recurrence occurred in 19 patients after operation, and the recurrence rate was 19.19%. Univariate analysis showed that postoperative stone recurrence was significantly associated with the factors that included age, jaundice, bile duct dilation, common bile duct diameter, stone maximum diameter and number, inflammation of the pancreas and procedure type(all P<0.05). Logistic regression analysis identified that age (OR=2.692, P=0.011), common bile duct diameter (OR=2.249, P=0.022), stone number(OR=2.647, P=0.017), maximum diameter of the stone (OR=2.348, P=0.009), combined inflammation (OR=2.801, P=0.013) and procedure type (OR=2.421, P=0.018) were the independent risk factors for stone recurrence. Conclusion: Postoperative stone recurrence in patients with gallbladder stones and concomitant common bile duct stones undergoing endoscopic treatment is affected by many factors, so the relevant measures should be tailored to specific conditions to reduce stone recurrence.