摘要
目的 探讨经皮经肝Ⅰ期胆道造瘘(PTOBF)取石术治疗肝胆管结石合并胆管狭窄患者术后结石复发的危险因素.方法 回顾性分析2016年9月至2023年2月在广州医科大学附属第一医院行PTOBF取石术治疗的70例肝胆管结石合并胆管狭窄患者的临床资料,其中男性28例,女性42例,年龄(48.9±17.5)岁.根据结石复发情况,将患者分为两组:复发组(n=25)与未复发组(n=45).记录患者的年龄、性别、病史、手术次数、带管时间等临床资料.通过电话和门诊复查方式进行随访.多因素logistic回归分析结石复发的影响因素.结果 单因素分析结果显示,复发组与未复发组患者的年龄、结石长径、结石数量、Ⅰ期未解除狭窄和手术次数间差异具有统计学意义(均P＜0.05).多因素 logistic 回归分析显示,结石长径≥20 mm(OR=4.389,95％CI:1.111～17.340,P=0.035)、Ⅰ期未解除狭窄(OR=4.638,95％CI:1.170～18.385,P=0.029)、手术次数多(OR=1.842,95％CI:1.031～3.290,P=0.039)的肝胆管结石合并胆管狭窄患者,PTOBF取石术后结石复发的风险高.结论 结石长径≥20 mm、Ⅰ期未解除狭窄、手术次数是肝胆管结石合并胆管狭窄患者PTOBF取石术后结石复发的独立危险因素.
Abstract
Objective Examining the risk factors for stone recurrence after percutaneous transhe-patic one-step biliary fistulation(PTOBF)and lithotripsy for hepatic bile duct stones.Methods The clini-cal data of 70 patients with hepatic bile duct stones combined with bile duct stenosis who underwent PTOBF lithotripsy at the First Hospital of Guangzhou Medical University from September 2016 to February 2023 were analyzed retrospectively,including 28 males and 42 females with the age of(48.9±17.5)years old.The patients were divided into two groups according to stone recurrence:recurrence group(n=25)and non-recurrence group(n=45).Clinical data such as age,gender,medical history,number of surgeries,and time with tube were recorded.Follow-up was performed by telephone and outpatient review.Multifactorial logistic regression was used to analyze the influencing factors of stone recurrence.Results Univariate analy-sis showed statistically significant differences between the age,stone length diameter,number of stones,stage Ⅰ undischarged stenosis,and number of surgeries between patients in the recurrent and non-recurrent groups(all P＜0.05).Multifactorial logistic regression analysis showed that stone length ≥20 mm(OR=4.389,95％CI:1.111-17.340,P=0.035),stage Ⅰ undischarged stenosis(OR=4.638,95％CI:1.170-18.385,P=0.029),and multiple number of operations(OR=1.842,95％CI:1.031-3.290,P=0.039)had a high risk of stone recurrence after PTOBF lithotripsy in patients with hepatic bile duct stones.Conclusion Stone length ≥20 mm,stage Ⅰ unresolved stenosis,and number of surgeries were independent risk factors for stone recurrence in patients with hepatobiliary stones combined with bile duct ste-nosis after PTOBF and lithotripsy for hepatic bile duct stones.
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