【摘要】：目的:探討膽總管結(jié)石經(jīng)內(nèi)鏡逆行胰膽管造影(Endoscopic Retrograde Cholangiopancreatography,ERCP)取石術(shù)后患者結(jié)石再發(fā)的危險(xiǎn)因素,為臨床治療及預(yù)防膽總管結(jié)石提供有效措施。方法:收集延邊大學(xué)附屬醫(yī)院2013年6月-2016年6月期間,226例確診為膽總管結(jié)石并且行ERCP治療的患者的臨床資料,符合標(biāo)準(zhǔn)的病例中分為復(fù)發(fā)組、未復(fù)發(fā)組兩組,根據(jù)一定標(biāo)準(zhǔn)按照性別、年齡、飲食習(xí)慣、體質(zhì)指數(shù)、膽道手術(shù)史、結(jié)石的直徑及數(shù)量、是否存在十二指腸憩室、是否合并膽總管狹窄、膽總管擴(kuò)張程度等相關(guān)因素進(jìn)行單因素統(tǒng)計(jì)學(xué)分析,然后將P0.05的單因素觀察值代入Logistic多因素回歸分析,計(jì)算出P及95%置信區(qū)間等統(tǒng)計(jì)學(xué)數(shù)值,最終找到結(jié)石復(fù)發(fā)的獨(dú)立危險(xiǎn)因素。結(jié)果:收集的226例病例其中死亡2例,13例無(wú)法取得聯(lián)系,共計(jì)211例病例符合標(biāo)準(zhǔn)。符合標(biāo)準(zhǔn)的病例中,有26例ERCP術(shù)后結(jié)石再發(fā),其復(fù)發(fā)率為12.32%。經(jīng)單因素統(tǒng)計(jì)分析結(jié)果示:復(fù)發(fā)組和未復(fù)發(fā)組在膽道手術(shù)史(P=0.001)、結(jié)石數(shù)量(P=0.031)、是否存在十二指腸憩室(P=0.001)、膽總管直徑(P=0.005)這四個(gè)方面差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。Logistic回歸分析后結(jié)果:最后只有三個(gè)因素有統(tǒng)計(jì)學(xué)意義:1.膽道手術(shù)史(OR:3.211,95%CI:1.329-7.760,P=0.010)2.膽總管直徑≥15mm(OR:3.268,95%CI:1.179-9.062,P=0.023)3.合并十二指腸憩室(OR:4.336,95%CI:1.525-12.329,P=0.006)結(jié)論:患者既往有膽道手術(shù)史、合并十二指腸憩室、膽總管直徑≥15mm是膽總管結(jié)石患者行ERCP術(shù)后結(jié)石再發(fā)的危險(xiǎn)因素。
[Abstract]:Objective: to explore the risk factors for the recurrence of choledocholithiasis after endoscopic retrograde cholangiopancreatography (Endoscopic Retrograde Cholangiopancreatography,ERCP) in order to provide effective measures for clinical treatment and prevention of choledocholithiasis. Methods: the clinical data of 226 patients with choledocholithiasis diagnosed and treated with ERCP from June 2013 to June 2016 in affiliated Hospital of Yanbian University were collected. According to certain criteria, according to sex, age, eating habits, body mass index, history of biliary tract surgery, diameter and number of stones, whether duodenal diverticulum exists or not, whether there is common bile duct stenosis, The degree of choledochus dilatation and other related factors were analyzed by univariate statistical analysis, and then the observation value of P05 was replaced by Logistic multivariate regression analysis, and the statistical values such as P and 95% confidence interval were calculated. Finally, independent risk factors for recurrence of stones were found. Results: among 226 cases, 2 cases died, 13 cases could not be contacted. A total of 211 cases met the standard. Among the patients who met the criteria, 26 patients had recurrent stones after ERCP, and the recurrence rate was 12.32. The results of univariate statistical analysis showed that the history of biliary tract surgery (P0. 001), the number of stones (P0. 031), and the presence of duodenal diverticulum (P0. 001) were found in recurrent and non recurrent groups. The differences of common bile duct diameter (P0. 005) were statistically significant (P0.05). Logistic regression analysis results: the last three factors were statistically significant: 1. History of biliary tract surgery (OR:3.211,95%CI:1.329-7.760,P=0.010) 2. The diameter of common bile duct 鈮，

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