内镜逆行胰胆管造影和开放式胆总管摄影术治疗胆总管综合征单次和多次复发的危险因素。

IF 2 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Gastroenterology Research and Practice Pub Date : 2023-10-31 eCollection Date: 2023-01-01 DOI:10.1155/2023/4738985
Yao Wu, Ying Zhang, Xiao Meng Jiang, Chen Jing Xu, Yan Yan Wang, Jin Yuan Gu, Yi Li, Shun Fu Xu
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引用次数: 0

摘要

背景:很少有研究比较内镜逆行胰胆管造影(ERCP)和胆总管切开术(OCT)的复发情况。目的:比较不同手术方法对胆总管结石单次和多次复发的影响。方法:对1255例经ERCP或OCT检查的胆总管结石患者进行回顾性分析。采用Kaplan-Meier法结合log-rank检验计算胆总管结石的复发率。通过在逻辑回归模型中引入单变量分析中P<0.20的变量,对复发性胆总管结石进行多变量分析。结果:共有204例(16.7%,204/1225)患者复发。在204例患者中,74.5%的患者在术后三年内复发,其中39.7%(81/204)有多次复发(≥ 2) 。ERCP的复发率(17.2%,119/692)高于OCT(15.1%,85/563),但差异无统计学意义。胆总管结石单次复发的独立危险因素为糖尿病、结石数量≥2、最大结石直径≥15 mm、久坐、ERCP(EST或EPBD)入路、壶腹周围憩室、一期缝合、高脂饮食(术后)、每周蔬菜摄入频率(结论:胆总管结石患者治疗后应定期随访1~3年 ≥ 2、糖尿病、壶腹周围憩室、手术方法、生活方式等都是胆总管结石复发的危险因素。ERCP仍然是首选的手术方法,因为它具有胆管炎复发风险低、住院时间短、手术微创、术后并发症少、老年患者更容易接受等优点。除了优化治疗计划外,术后生活方式管理也至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Risk Factors for Single and Multiple Recurrences for Endoscopic Retrograde Cholangiopancreatography and Open Choledochotomy in Treating Choledocholithiasis.

Risk Factors for Single and Multiple Recurrences for Endoscopic Retrograde Cholangiopancreatography and Open Choledochotomy in Treating Choledocholithiasis.

Risk Factors for Single and Multiple Recurrences for Endoscopic Retrograde Cholangiopancreatography and Open Choledochotomy in Treating Choledocholithiasis.

Risk Factors for Single and Multiple Recurrences for Endoscopic Retrograde Cholangiopancreatography and Open Choledochotomy in Treating Choledocholithiasis.

Background: There are few studies comparing recurrences between endoscopic retrograde cholangiopancreatography (ERCP) and open choledochotomy (OCT).

Aims: To compare the effect of different surgical methods on single and multiple recurrences of choledocholithiasis.

Methods: A total of 1255 patients with choledocholithiasis who underwent ERCP or OCT were retrospectively studied. The recurrence of choledocholithiasis was calculated by the Kaplan-Meier method with the log-rank test. Multivariate analyses of recurrent choledocholithiasis were performed by introducing variables with P < 0.20 in univariate analysis into the logistic regression model.

Results: A total of 204 (16.7%, 204/1225) patients relapsed. Among the 204 patients, 74.5% relapsed within three years after surgery, of whom 39.7% (81/204) had multiple relapses (≥ 2). The recurrence rate of ERCP (17.2%, 119/692) was higher than that of OCT (15.1%, 85/563), but the difference was not statistically significant. The independent risk factors for a single recurrence of choledocholithiasis were diabetes, stone number ≥ 2, maximum stone diameter ≥ 15 mm, sedentary occupation, the approach of ERCP (EST or EPBD), periampullary diverticulum, primary suture, high-fat diet (postoperative), frequency of weekly vegetable intake (< 4, postoperative), and drinking (postoperative). However, the ERCP approach (EST or EPBD), OCT approach (LCBDE), primary suture, high-fat diet (postoperative), and frequency of weekly vegetable intake (< 4, postoperative) were independent risk factors for multiple recurrences of choledocholithiasis.

Conclusion: Patients with choledocholithiasis should be followed up regularly for one to three years after treatment. Stone number ≥ 2, diabetes mellitus, periampullary diverticulum, surgical methods, and lifestyle are all risk factors for the recurrence of choledocholithiasis. ERCP is still the preferred surgical method based on the advantages of low risk of cholangitis recurrence, less hospital stay, minimally invasive surgery, fewer postoperative complications, and easier acceptance by elderly patients. In addition to optimizing the treatment plans, postoperative lifestyle management is also vital.

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来源期刊
Gastroenterology Research and Practice
Gastroenterology Research and Practice GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.40
自引率
0.00%
发文量
91
审稿时长
1 months
期刊介绍: Gastroenterology Research and Practice is a peer-reviewed, Open Access journal which publishes original research articles, review articles and clinical studies based on all areas of gastroenterology, hepatology, pancreas and biliary, and related cancers. The journal welcomes submissions on the physiology, pathophysiology, etiology, diagnosis and therapy of gastrointestinal diseases. The aim of the journal is to provide cutting edge research related to the field of gastroenterology, as well as digestive diseases and disorders. Topics of interest include: Management of pancreatic diseases Third space endoscopy Endoscopic resection Therapeutic endoscopy Therapeutic endosonography.
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