胆总管结石取石术后结石复发的危险因素Logistic回归分析

Logistic regression analysis of risk factors of recurrence of choledocholithiasis after choledocholithotomy

摘要:

目的  探讨胆总管结石取石术后结石复发的危险因素。方法  回顾性分析2004年9月-2014年9月在该院行胆总管切开取石手术214例患者的临床资料。其中，术后结石复发患者80例作为观察组，结石未复发患者134例作为对照组，对比两组患者的一般资料，采用χ2检验和t检验进行单因素分析，采用Logistic回归分析进行多因素分析，筛选胆总管取石术后结石复发的独立危险因素。结果  单因素分析结果显示，观察组和对照组在年龄、乙型肝炎病毒感染、乳头旁憩室、胆道感染、胆道手术史、胆囊结石、胆囊切除、胆总管直径≥1.5 cm、胆管角≤120°、胆道狭窄、乳头狭窄、Oddis括约肌功能障碍、胆固醇结石、结石直径≥1 cm、结石数量≥2等方面比较，差异有统计学意义（P <0.05）。Logistic回归分析结果显示，胆道手术史[■=2.692（95%CI：1.906，6.884）P =0.024]，乳头旁憩室[■=3.201（95%CI：1.993，6.756）P =0.032]，胆总管直径≥1.5 cm[■=3.234（95%CI：1.742，6.875）P =0.024]，胆管角≤120°[■=2.305（95%CI：1.822，6.901）P =0.021]为胆总管结石取石术后复发的独立危险因素。结论  胆总管结石取石术后复发的影响因素有很多，应加强预防措施，如控制胆道感染、解除胆道梗阻、改善胆道动力等，标本兼治尚能有效地解决胆总管结石取石术后复发的问题。

Abstract:

Objective To explore the risk factors of recurrence of choledocholithiasis after choledocholithotomy. Methods The clinical data of 214 patients with common bile duct calculi who received choledocholithotomy from September 2004 to September 2014 were retrospectively analyzed. The 80 cases with choledo-cholithiasis recurrence were taken as observation group, the 134 cases without recurrence as control group. The clinical data of the two groups were compared. For single-factor analysis t and χ2 tests were adopted, while logistic regression analysis was used for multiple-factor analysis. Results The results of single-factor analysis showed that the two groups had statistically significant differences in age, HBV infection, periampullary diverticula, infection of biliary tract, biliary surgery history, gallstones, gallbladder excision, diameter of common bile duct ≥1.5 cm, bile duct angle ≤120°, biliary stricture, papillary stenosis, Oddis sphincter dysfunction, stone with diameter ≥1 cm, number of stone ≥2 (P < 0.05). Logistic regression analysis showed that biliary surgery history [■ = 2.692 (95% CI: 1.906, 6.884), P = 0.024], periampullary diverticula [■ = 3.201 (95% CI: 1.993, 6.756), P = 0.032], diameter of common bile duct ≥1.5 cm [■ = 3.234 (95% CI: 1.742, 6.875), P = 0.024] and bile duct angle ≤120° [■ = 2.305 (95% CI: 1.822, 6.901), P = 0.021] were the independent risk factors of the recurrence of choledocholithiasis after choledocholithotomy. Conclusions There are many influence factors of recurrence of common bile duct calculi after choledocholithotomy. The preventive measures should be strengthened, such as controlling biliary infection, relieving biliary obstruction and improving biliary dynamics to solve the recurrence problems after choledocholithotomy.