保胆取石术后结石复发的相关影响因素分析
| 作者: |
1刘强,
1陈士水,
1邵慧成,
1孟庆东,
1吕晔源,
1赵君
1 山东省医学科学院第三附属医院 肝胆外科 / 山东省寄生虫病防治研究所，山东 济宁 272033 |
| 通讯: |
赵君
Email: ssliuq2004@163.com |
| DOI: | 10.3978/.2018.08.006 |
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。
关键词：
胆囊结石病；器官保留治疗；复发；危险因素
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。
Analysis of factors associated with postoperative stone recurrence after gallbladder-preserving cholecystolithotomy
CorrespondingAuthor:ZHAO Jun Email: ssliuq2004@163.com
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. Th e 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%). Th e 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.
Keywords：
Cholecystolithiasis; Organ Sparing Treatments; Recurrence; Risk Factors
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. Th e 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%). Th e 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.