Long‐term gallbladder stone recurrence and risk factors after successful lithotripsy
Long‐term gallbladder stone recurrence and risk factors after successful lithotripsy
复制标题
碎石成功后长期胆囊结石复发及危险因素
DOI：
10.1097/00042737-200012020-00013
复制
发表时间：
2000
影响因子：
2.1
通讯作者：
M. Moura
中科院分区：
文献类型：
--
作者：
Luís Carrilho;A. Pinto;J. Velosa;M. Moura
目的复发的风险限制了胆囊结石保守治疗的可接受性。本研究的目的是确定冲击波碎石成功后结石复发率及其危险因素。设计：每隔一年或报告胆道疼痛时进行前瞻性超声随访。方法对158例患者(单结石13 0例，二结石或三结石28例)在结石消失后停用熊去氧胆酸后随访至70个月(中位数33个月)。结果43例患者术后结石复发。经精算分析，1、2、3、4、5年复发率(%)分别为：6±2、14±3、27±4、35±5、44±6(观察值±SE)。Cox回归分析表明，高体重指数是新形成结石的危险因素(P=0.02)。只有一颗原石似乎并不能起到保护作用。43例患者中有14例(33%)有早期复发症状。38例患者(%)选择再次进行口腔溶解，8例患者(19%)辅以碎石治疗。结论结石碎石术和熊去氧胆酸治疗后5年的胆结石复发率并不比胆汁酸治疗后的研究报道的低。肥胖是结石复发的危险因素，对原发结石也是如此。大多数继发性结石患者选择再次进行保守治疗。胆结石复发仍然是这些治疗的主要缺点之一，需要有成本效益的策略来预防。欧洲胃肠病肝素12：209-215©2000 Lippincott Williams&Wilkins欧洲胃肠病与肝病杂志2000，12：209-215
Objective The risk of recurrence has limited the acceptability of conservative therapies of gallbladder stones. The aim of the present study was to determine the rate of stone recurrence and its risk factors, after successful shock‐wave lithotripsy. Design Prospective ultrasound follow‐up at yearly intervals or whenever biliary pain was reported. Methods One hundred and fifty‐eight consecutive patients (single stone, n = 130; two or three stones, n = 28) were followed up to 70 months (median, 33 months) after stone disappearance and discontinuation of ursodeoxycholic acid. Results Forty‐three patients developed recurrent stones. By actuarial analysis, the recurrence rates (as a percent) at 1, 2, 3, 4 and 5 years were, respectively: 6 ± 2, 14 ± 3, 27 ± 4, 35 ± 5, and 44 ± 6 (observed ± SE). Cox's regression analysis identified high body mass indexes to be a risk factor (P = 0.02) for newly formed stones. Having had a single primary stone did not seem to be protective. Fourteen of the 43 patients (33%) had early symptoms of recurrence. Thirty‐eight patients (89%) chose to undergo oral dissolution again, which was complemented by lithotripsy in eight patients (19%). Conclusion The 5‐year gallbladder stone recurrence after lithotripsy and ursodeoxycholic acid is not substantially smaller than that reported by post‐bile acid studies. Obesity is a risk factor for recurrent stones as it is for primary stones. Most patients with secondary stones choose to have conservative therapy again. Gallbladder stone recurrence still is one of the major drawbacks of these treatments and cost‐effective strategies are needed to prevent it. Eur J Gastroenterol Hepatol 12:209‐215 © 2000 Lippincott Williams & Wilkins European Journal of Gastroenterology & Hepatology 2000, 12:209‐215