十二指肠镜联合腹腔镜治疗胆囊结石并肝外胆管结石术后胆总管结石复发的高危因素分析

目的 探讨十二指肠镜联合腹腔镜治疗胆囊结石并肝外胆管结石术后胆总管结石复发的高危因素,为临床防治提供参考.方法 选取140例十二指肠镜联合腹腔镜治疗的胆囊结石并肝外胆管结石患者作为研究对象,将其中20例胆总管结石复发患者作为复发组,其余120例作为未复发组,对两组患者相关因素进行单因素和多因素非条件的logistic回归分析.结果单因素分析结果显示复发组与未复发组胆总管结石的数量(3.3 ±0.5)vs(1.3 ±0.4)例]、胆总管直径(2.1 ±0.4)vs (1.5 ±0.3)cm]、高胆固醇血症(8.6 ±2.1)vs(5.2 ±1.5)mmol· L-1]、乳头旁憩室(25.0% vs 5.8%)、合并胆管炎(60.0%vs 34.2%)、体质量指数(28.5 ±3.6)vs(24.6 ±4.1)kg· m-2]、术后胆道积气(50.0%vs 21.7%)与胆总管结石直径(1.5 ±0.3)vs(0.8 ±0.2)cm]比较,差异有统计学意义(P<0.05);多因素非条件的logistic回归分析显示胆总管结石的数量、胆总管直径、乳头旁憩室、合并胆管炎及术后胆道积气是术后胆总管结石复发的独立危险因素(P<0.05).结论 对影响两镜治疗后胆总管结石复发的相关危险因素积极进行干预,对防治胆总管结石复发具有重要的临床意义.

High risk factors for postoperative recurrent choledocholithiasis by duodenoscopy and laparoscopy

Objective To explore the related high risk factors of postoperative recurrent choledocholithiasis by duodenoscopy and lapa -roscopy,and to provide reference for clinical prevention and treatment.Methods One hundred and forty cases of cholelithiasis were analyzed from January 2013 to January 2015.There were 20 cases of patients with postoperative recurrent choledocholithiasis(recur-rence group),while the rest 120 patients were in no recurrence group.The related factors of two groups were analyzed by logistic regres-sion with single factor and multifactor condition.Results Single factor analysis results showed that the differences of the number of choledocholithiasis(3.3 ±0.5)vs(1.3 ±0.4)cases],choledocholithiasis diameter(2.1 ±0.4)vs(1.5 ±0.3)cm],hyperchol-esterolemia(8.6 ±2.1)vs(5.2 ±1.5)mmol· L-1],nipple diverticulum(25.0% vs 5.8%),cholangitis(60.0% vs 34.2%), body mass index(28.5 ±3.6)vs(24.6 ±4.1)kg· m-2],biliary postoperative pneuma tosis(50.0% vs 21.7%),diameter of choledocholithiasis(1.5 ±0.3)vs(0.8 ±0.2)cm]in the recurrence group and non-recurrence group had statistical significant (P<0.05).Multifactor unconditioned logistic regression analysis showed that the number of choledocholithiasis,choledocholithiasis di-ameter,nipple diverticulum,cholangitis,biliary postoperative pneumatosis were independent risk factors for postoperative recurrent cho -ledocholithiasis(P<0.05).Conclusions Positive intervention measures are put into effect for postoperative recurrent choledocholith -iasis by duodenoscopy and laparoscopy.It has important clinical significance for the prevention and treatment of postoperative recurrent choledocholithiasis.