Assessment of postoperative common bile duct stones after endoscopic extraction and subsequent cholecystectomy.
Assessment of postoperative common bile duct stones after endoscopic extraction and subsequent cholecystectomy.
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内镜下取出胆囊切除术后胆总管结石的评估。
DOI：
10.1007/s00464-022-09017-z
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Sakamoto N.
中科院分区：
文献类型：
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作者：
Sugiura R;Nakamura H;Horita S;Meguro T;Sasaki K;Kagaya H;Yoshida T;Aoki H;Morita T;Fujita M;Tamoto E;Fukushima M;Ashitate Y;Ueno T;Tsutaho A;Kuwatani M;Sakamoto N.
胆总管结石(CBDS)有时会导致严重的疾病，而内窥镜下取石是胆总管结石的标准治疗方法。为预防胆道并发症，建议对经内窥镜胆总管摘除术后出现胆囊结石的患者行胆囊切除术。然而，CBD偶尔会复发。到目前为止，内窥镜下胆总管摘除和随后的胆囊切除术后发生胆总管畸形的原因还不完全清楚。因此，本研究旨在评估术后胆总管结石的发生率。方法这项回顾性观察研究包括2012年4月至2021年6月在我所进行的连续的经内窥镜胆总管取出后行逆行胆道造影术的患者。在内窥镜胆总管取出后，置入胆道塑料支架以预防梗阻性胆管炎。采用内窥镜逆行胆道造影术评价术后CBDS，直至出院。结果是术后CBDS和CBDS/污泥的发生率。结果在符合条件的204例患者中，52例(25.5%)出现了术后CBDS。CBDS/污泥发生率为36.8%(n= 75)。单因素分析显示，胆囊管结石、 ≥ 6胆管结石和 ≥ 10 GB结石是术后胆管结石发生的显著预测因素(P<； 0.0 5)。此外，男性和 <； 60 mm短轴可能是GB的预测因素(P<； 0.10)。多因素分析显示， ≥ 6胆管结石(优势比 = 6.6 5，P<； 0.0 1)、有无胆囊管结石(优势比 = 4.39，P<； 0.0 1)和 ≥ 10 GB结石(优势比 = 2.55，P= 0.0 1)是术后胆管结石的独立预测因素。因此，具有术后CBD预测因素的患者必须在胆囊切除术后接受影像检查或附加的内窥镜检查。
BackgroundCommon bile duct stones (CBDSs) occasionally cause serious diseases, and endoscopic extraction is the standard procedure for CBDS. To prevent biliary complications, cholecystectomy is recommended for patients who present with gallbladder (GB) stones after endoscopic CBDS extraction. However, CBDS can occasionally recur. To date, the occurrence of CBDS after endoscopic CBDS extraction and subsequent cholecystectomy is not fully understood. Hence, the current study aimed to evaluate the incidence of postoperative CBDSs.MethodsThis retrospective observational study included consecutive patients who underwent postoperative endoscopic retrograde cholangiography after endoscopic CBDS extraction and subsequent cholecystectomy between April 2012 and June 2021 at our institution. After endoscopic CBDS extraction, a biliary plastic stent was inserted to prevent obstructive cholangitis. Endoscopic retrograde cholangiography was performed to evaluate postoperative CBDSs after cholecystectomy until hospital discharge. The outcomes were the incidence of postoperative CBDSs and CBDSs/sludge. Moreover, the predictive factors for postoperative CBDSs were evaluated via univariate and multivariate analyses.ResultsOf eligible 204 patients, 52 patients (25.5%) presented with postoperative CBDSs. The incidence rate of CBDS/sludge was 36.8% (n= 75). Based on the univariate analysis, the significant predictive factors for postoperative CBDSs were ≥ 6 CBDSs, presence of cystic duct stones, and ≥ 10 GB stones (P< 0.05). Moreover, male sex and < 60-mm minor axis in GB might be predictive factors (P< 0.10). Based on the multivariate analysis, ≥ 6 CBDSs (odds ratio = 6.65,P< 0.01), presence of cystic duct stones (odds ratio = 4.39,P< 0.01), and ≥ 10 GB stones (odds ratio = 2.55,P= 0.01) were independent predictive factors for postoperative CBDSs.ConclusionsThe incidence of postoperative CBDS was relatively high. Hence, patients with predictive factors for postoperative CBDS must undergo imaging tests or additional endoscopic procedure after cholecystectomy.