多次胆道取石术后复发的影响因素分析

发布时间：2018-02-25 07:14

本文关键词： 影响因素胆道镜技术结石复发多次胆道取石术后　出处：《福建医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的如今腹腔镜技术、胆道镜技术在治疗胆总管结石、肝内胆管结石等方面已取得卓越的进步,但是胆道结石复发问题一直是个棘手的问题,尤其是多次胆道取石术后结石再复发患者。由此,寻找多次胆道取石术后结石再复发的影响因素的重要性由此凸显,通过患者年龄、性别、营养状态、术后随访检查、治疗结果等因素评估,寻找引起多次胆道取石术后结石复发的可能因素,从而为该患者临床治疗及诊断提供指导。方法回顾性研究福建医科大学附属第一医院肝胆胰外科自2010年1月至2014年12月行多次胆道取石术后的256例患者的临床资料,由于术后随访病史资料不全等原因,最终194例多次胆道取石术后患者纳入本研究,通过对多次胆道取石术后患者的临床资料、检验和影像学、术后操作等因素进行单因素分析及二分类非条件Logistic回归模型分析。结果194例多次胆道取石术后患者纳入本研究,结石再复发146例,结石未复发患者48例。单因素分析显示多次胆道取石术后结石再复发组和未复发组患者性别(χ2=4.042,P=0.044)、BMI(Body Mass Index,身体质量指数)(H=10.087,P0.001)、术后复查影像学结果(χ2=75.57,P0.001)、末次残余结石(χ2=24.102,P0.001)、术后胆道残余结石数量(H=93.186,P0.001)、残余结石直径(H=51.359,P0.001)、总胆红素(χ2=4.126,P=0.042)、GGT(gamma-glutamyl transpeptidase,γ-谷氨酰基转移酶)(χ2=9.215,P=0.002)差异具有统计学意义(P0.05)。二分类非条件Logistic回归分析示术后复查影像学等结果(P=0.013,OR=0.047,OR 95%CI=0.004~0.532)、术后胆道残余结石数量(P0.001,OR=20.508,OR95%CI=7.500~56.080)是多次胆道取石术后结石复发的影响因素。结论对于多次胆道取石术后患者,术后取尽胆道结石有利于预防多次行胆道取石手术术后结石复发,术后复查影像学结果有助于早期诊断、早期发现结石。
[Abstract]:Objective Laparoscopy and choledochoscopy have made great progress in the treatment of choledocholithiasis and intrahepatic cholelithiasis, but the recurrence of cholelithiasis has always been a thorny problem. The importance of finding the influencing factors for the recurrence of stones after multiple choledocholithotomy is highlighted, and the patients' age, sex, nutritional status, postoperative follow-up examination, and so on are the most important factors in finding out the factors affecting the recurrence of stones after multiple choledocholithotomy. The results of treatment were evaluated to find out the possible factors that caused the recurrence of stones after multiple bile duct lithotomy. Methods the clinical data of 256 patients undergoing multiple cholelithiasis from January 2010 to December 2014 in the Department of Hepatobiliary and Pancreatic surgery of the first affiliated Hospital of Fujian Medical University were retrospectively studied. As a result of incomplete follow-up data, 194 patients after multiple biliary tract lithotomy were included in this study. The clinical data, examination and imaging of the patients after multiple biliary tract lithotomy were analyzed. The factors such as operation were analyzed by univariate analysis and two-class non-conditional Logistic regression model analysis. Results one hundred and forty-four patients after multiple bile duct lithotomy were included in this study. The univariate analysis showed that the patients with recurrent stones and those without recurrence after multiple choledocholithiasis removal were male and female (蠂 2 / 4.042 / 0. 044 BMIBody Mass Index, BMI = 10.087 / P 0.001). The imaging results were reviewed (蠂 ~ 2 75.57 / P 0.001, 蠂 ~ 2 / 75.57 / P 0.001, 蠂 ~ 2 = 24.102 / P _ 0.001). Postoperative choledocholithiasis (蠂 ~ 2 / 75.57 / P _ 0.001, 蠂 ~ 2 = 24.102 / P _ 0.001, P _ (0.001), P _ (0.001), P _ (0.001), P _ (0.001)). The total bilirubin, total bilirubin, GGTgamma-glutamyl transpeptidase (GGTgamma-glutamyl transpeptidase), 纬 -glutamyl transferase (蠂 29.215P0. 002) were statistically significant (P 0.05). The Logistic regression analysis showed that the postoperative imaging results were P 0.013 OR0.047 OR 0.002, respectively. The quantity of stone (P 0.001) was 20.508 / Or95CI7.500 / 56.080), which was the influencing factor for the recurrence of stones after repeated choledocholithotomy. Conclusion for the patients after multiple choledocholithiasis, there is no significant difference in the number of stones after repeated choledocholithotomy. Postoperative choledocholithiasis is helpful to prevent the recurrence of stones after repeated choledocholithotomy, and the imaging results are helpful to early diagnosis and early discovery of stones.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

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