目的 探讨微创内镜保胆取石术后结石复发率及影响因素,以合理选择手术适应证、降低结石复发率.方法 对我院1998年1月至2003年1月微创内镜保胆取石术后65例患者的临床资料和随访资料进行分析研究.结果 微创内镜保胆取石术后结石总的复发率为38.5%(25例),5例再次行胆囊切除术,占复发患者的20.0%.单因素分析得出5个与结石复发相关因素,胆囊功能[正常6.3%(2/32)比减低69.7%(23/33),P＜0.01]、胆囊壁厚度[≥0.3 cm者78.3%(18/23)比＜0.3 cm者16.7%(7/42),P＜0.01]、家族史[有家族史者63.0%(17/27)比无家族史者21.1%(8/38),P＜0.01]、血甘油三酯水平[(4.45±2.16)mmol/L比(3.37±2.35)mmol/L,P＜0.01]、术后是否服用熊去氧胆酸[服用者18.2%(4/22)比未服用者48.8%(21/43),P＜0.05];最后引入COX回归分析进行多因素分析,得到2个影响复发的因素,分别是胆囊功能和胆囊壁厚度(B=1.747、-1.123,SE=0.855、0.507,Wald=4.172、4.902,P=0.041、0.027,Exp (B)=5.737、0.325).结论 胆囊功能、胆囊壁厚度是影响结石复发的重要因素,前瞻性判断保胆取石后结石复发的可能性,有利于合理选择手术适应证,降低术后结石复发率.%Objective To explore recurrent rate of the gallstone after cholecyst olithotomy and identify the variables predicting the recurrence. Methods A retrospective analysis of 65 patients among 70 patients who were in hospital from 1998 to 2003 was performed. Results The total recurrent rate was 38.5%. There were 5 factors might influent the recurrent rates byx2 test, such as function of gallbladder, the thickness of gallbladder wall, Ursodeoxycholic acid, family history of gallstone, triglyceride in blood. Two factors among them were identified as independent risk factors for recurrence by multivariate model: function of gallbladder, the thickness of gallbladder wall. The gallstone recurrent rate of patient who has normal function of gallbladder and thickness of gallbladder wall ＜ 0. 3 cm is 8.0%. Conclusions Function of gallbladder, the thickness of gallbladder wall and triglyceride in blood are strong predictors for recurrence after cholecystolithotomy. The gallstone recurrent rate is low among those patients who have normal function of gallbladder andthickness of gallbladder wall ＜0.3 cm.
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