保胆取石术后结石复发的相关影响因素分析
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赵君, Email: ssliuq2004@163.com

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刘强,山东省医学科学院第三附属医院副主任医师,主要从事肝胆管结石及肝胆肿瘤外科治疗方面的研究。


Analysis of factors associated with postoperative stone recurrence after gallbladder-preserving cholecystolithotomy
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    摘要:

    目的:探讨胆囊结石患者保胆取石术后复发的相关影响因素。 方法:收集2010年5月—2014年5月在行保胆取石手术的胆囊结石患者400例的临床资料与随访资料,分析患者术后结石复发相关的因素。 结果:400例患者平均随访时间为(34.2±3.6)个月,胆囊结石复发者42例(10.5%)。单因素分析结果显示,胆囊结石家族史、胆囊壁厚度、结石数量以及三酰甘油的水平与术后结石复发有关(均P<0.05);多因素Logistic回归分析表明,胆石症家族史(OR=10.231,95% CI=6.344~48.343,P=0.008)、胆囊壁厚度≥4 mm(OR=2.312,95% CI=1.223~12.156,P=0.023)、结石多发(OR=4.568,95% CI=3.213~15.328,P=0.015)以及三酰甘油的水平≥1.71 mmol/L(OR=2.556,95% CI=1.643~15.312,P=0.041)是术后结石复发的独立危险因素。 结论:有胆石症家族史、胆囊壁厚度≥4 mm、结石多发以及三酰甘油的水平≥1.71 mmol/L是胆囊结石患者行保胆取石术后复发的危险因素,对于有以上因素的患者,应给予合适的预防措施或不采用保胆取石术。

    Abstract:

    Objective: To investigate the related factors for stone recurrence in patients with gallbladder stones after gallbladder-preserving cholecystolithotomy. Methods: The clinical and follow-up data of 400 patients with gallbladder stones undergoing gallbladder-preserving cholecystolithotomy from May 2010 to May 2014 were collected. The factors for postoperative stone recurrence of the patients were analyzed. Results: In the 400 patients, the average follow-up time was (34.2±3.6) months, and gallbladder stone recurrence occurred in 42 cases (10.5%). The results of univariate analysis showed that having a family history of gallstones, degree of gallbladder wall thickness, number of stones and triacylglycerol level were significantly associated with postoperative stone recurrence (all P<0.05); multivariate Logistic regression analysis revealed that having a family history of gallstones (OR=10.231, 95% CI= 6.344–48.343, P=0.008), gallbladder wall thickness ≥4 mm (OR=2.312, 95% CI=1.223–12.156, P=0.023), multiple gallstones (OR=4.568, 95% CI=3.213–15.328, P=0.015) and triacylglycerol level ≥1.71 mmol/L (OR=2.556, 95% CI=1.643–15.312, P=0.041) were independent risk factors for postoperative stone recurrence. Conclusion: Having a family history of gallstones, gallbladder wall thickness ≥4 mm, multiple gallstones and triglyceride level ≥1.71 mmol/L are risk factors for postoperative stone recurrence in gallstone patients after gallbladder-preserving stone extraction. For patients with these factors, the appropriate preventive measures should be considered or gallbladder-preserving procedure should not be performed.

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刘强, 陈士水, 邵慧成, 孟庆东, 吕晔源, 赵君.保胆取石术后结石复发的相关影响因素分析[J].中国普通外科杂志,2018,27(8):983-988.
DOI:10.3978/j. issn.1005-6947.2018.08.006

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  • 收稿日期:2018-05-05
  • 最后修改日期:2018-07-14
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  • 在线发布日期: 2018-08-15