摘要
目的分析胆管末端良性病变经ERCP治疗后复发胆管炎的危险因素,评价ERCP治疗远期效果的同时确定随访对该类患者的重要性。方法回顾性分析2010年至2014年行ERCP诊治的150例胆管末端良性病变合并胆管炎患者的临床数据,并通过随访评价ERCP治疗该类疾病的效果。结果经ERCP成功造影132例,成功率为88.0%,术后共出现胆管炎复发22例,占17.5%(122/126),男性胆管炎复发率高于女性(P=0.138),憩室组复发率高于非憩室组(P=0.023),合并胆囊结石组的复发率高于无胆囊结石组(P=0.016),胆囊切除组胆管炎复发率低于胆囊非切除组(P=0.003),乳头括约肌切开(EST)组的复发率高于非EST组(P=0.045),对年龄、性别、并憩室、并胆囊结石、胆囊切除史、EST治疗等进行Logistic回归分析显示,年龄、合并憩室、EST治疗为胆管炎复发的独立危险因素,合并胆囊结石与术后复发有关(P=0.000),胆囊切除史及性别为男时为复发的保护性因素(P=0.000)。结论胆管末端良性病变包括十二指肠乳头炎、十二指肠乳头括约肌功能障碍、胆管泥沙样结石、壶腹周围憩室等,多病因交叉存在、互相影响,对胆管末端疾病的诊治要有全局观念,从整体出发;ERCP对该类疾病安全有效,该类疾病具有易复发的特点,且有恶变的可能,随访对于该类疾病具有非常重要的作用。
Objective To analyze the risk factors of recurrent cholangitis of the benign lesion of the bile duct after ERCP treatment, to evaluate the long-term effects of ERCP and to determine the importance of follow-up for the patients. Methods The clinical data of 150 patients with benign lesion and eholangitis after ERCP treatment from 2010 to 2014 were analyzed retrospectively. The effect of ERCP on the treatment of the disease by follow-up was evaluated. Results ERCP was successful in 132 cases （88.0%） , and the recurrence of cholangitis after surgery was 22, accounting for 17.5% （122/ 126） , the recurrence rate of male was higher than that of female （P = 0. 138）. The recurrence rate of diverticulum group was higher than that of non-diverticular group （P = 0. 023）. The relapse rate of cholecystectomy group was lower than that of gallbladder non-resection group （P = 0. 003）. The relapse rate of EST group was higher than that of non- cholecystolithiasis group （P = 0. 016） and non-EST group （P = 0. 045 ）. Logistic regression analysis showed that age, merge diverticulum, EST treatment were independent risk factors for recurrence of cholangitis. The gallbladder stone was associated with postoperative recurrence of cholangitis （P = 0. 000）. The history of cholecystectomy and male gender were protective factors for recurrence of cholangitis （P = 0. 000）. Conclusion The benign lesions include duodenal papillitis, Oddi sphincter dysfunction, common bile duct microlithiasis, periampullary diverticulum. There are multiple etiologies interdependent and influence each other. The diagnosis and treatment of terminal bile duct disease should be global, ERCP is safe and effective for these diseases. It has the characteristics of easy recurrence and the possibility of malignancy. Follow-up plays a very important role in the disease.
出处
《胃肠病学和肝病学杂志》
CAS
2017年第12期1413-1416,共4页
Chinese Journal of Gastroenterology and Hepatology
