Risk factors for recurrent common bile duct stones: a systematic review and meta-analysis
Risk factors for recurrent common bile duct stones: a systematic review and meta-analysis
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DOI：
10.1080/17474124.2023.2242784
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发表时间：
2023-08
影响因子：
3.9
通讯作者：
Ningyuan Wen;Yaoqun Wang;Yulong Cai;Guilin Nie;Si-shu Yang;Shaofeng Wang;X. Xiong;Bei Li;Jiong Lu;Nansheng Cheng
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文献类型：
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作者：
Ningyuan Wen;Yaoqun Wang;Yulong Cai;Guilin Nie;Si-shu Yang;Shaofeng Wang;X. Xiong;Bei Li;Jiong Lu;Nansheng Cheng
摘要背景：据报道，胆总管结石（CBDS）在取石后的复发率为4%-24%。最常用的取石方法是内镜下胰胆管造影术（ERCP）。我们进行了一项系统综述和荟萃分析，以确定结石取出后复发CBDS的所有可用风险因素。研究设计和方法采用病例对照设计进行文献检索，以确定复发性CBDS的潜在危险因素。分析不同危险因素对结石复发的影响。计算合并比值比（OR）及95% CI和异质性。在质量评估后，将识别出的风险因素分级为“强”、“中等”或“弱”。结果共纳入46篇关于ERCP治疗后结石复发的研究。胆总管直径1.5 cm、胆总管角度尖锐、多次ERCP、术后活动受限、胆总管切开史和胆道支架置入被确定为强风险因素;胆总管直径较大、壶腹周围憩室、机械碎石术和胆囊切除术史被确定为中度风险因素。还列出了其他弱风险因素。结论：在这项综合性研究中，我们确定了ERCP后CBDS复发的14个风险/保护因素。计算合并比值比并评价证据质量。这些发现对CBDS的评估和管理有一定的指导意义。
ABSTRACT Background Common bile duct stones (CBDS) have a reported recurrence rate of 4%-24% after stone extraction. The most commonly applied stone extraction method is endoscopic cholangiopancreatography (ERCP). We conducted a systematic review and meta-analysis to identify all available risk factors for recurrent CBDS following stone retraction. Research design and methods A literature search of studies with case-control design was performed to identify potential risk factors for recurrent CBDS. The impact of different risk factors on stone recurrence was analyzed. Pooled odds ratios (ORs) with 95% CIs and heterogeneity were calculated. Identified risk factors were graded as ‘strong,’ ‘moderate,’ or ‘weak’ after quality assessment. Results A total of 46 studies discussing stone recurrence following ERCP treatment were included. CBD diameter 1.5 cm, sharp CBD angulation, multiple ERCP sessions, postoperative pneumobilia, history of CBD incision, and biliary stent placement were identified as strong risk factors; larger CBD diameter, periampullary diverticulum, mechanical lithotripsy, and history of cholecystectomy were identified as moderate. Other weak risk factors were also listed. Conclusions In this comprehensive study, we identified 14 risk/protective factors for recurrent CBDS following ERCP. Pooled odds ratios were calculated and evaluated the quality of evidence. These findings may shed light on the assessment and management of CBDS.