内镜与腹腔镜联合治疗胆囊结石合并胆总管结石效果及相关因素分析

摘要

Objective:To discuss the clinical outcome and relative factors of endoscopic and laparoscopic combined treatment for patients with gallstones and concomitant choledocholithiasis.Method:From April 2010 to April 2013,the clinical data of 127 patients diagnosed as gallstones and concomitant choledocholithiasis by iconography and treated by endoscopic and laparoscopic combined treatment were retrospective analyzed.And the correlation between lithotomy successful,no recurrence and clinical factors were analyzed by single factor related analysis and Logistic regression analysis.Result:The successful people accounted for 78.74%(100/127) and calculi residual accounted for 21.26%(27/127).No relapses accounted for 85.04%(108/127) and relapses accounted for 14.96%(19/127) after endoscopic and laparoscopic combined treatment.The single factor related analysis found that lithotomy successful and without recurrence were related to patient age,number of stones,stones of maximum diameter,diameter of common bile duct,no bile duct expansion,common bile duct expansion, merger cholangitis or pancreatitis.In addition,no relapse was also related to lithotomy successful,no history of jaundice and no postoperative complications. The Logistic regression analysis showed that number of stones,diameter of common bile duct,no bile duct expansion,no common bile duct expansion and no combination of cholangitis were the most important of lithotomy successful and without recurrence.In addition,age,no residual stones and no postoperative complications were the most important of without recurrence.Conclusion:Age<55 years old,number of stones<10,no residual stones,diameter of common bile duct≥1 cm,no bile duct expansion,no common bile duct expansion,no combination of cholangitis and no postoperative complications can be used as the predictors of therapeutic success for patients with gallstones and concomitant choledocholithiasis.%目的：探讨内镜与腹腔镜联合治疗胆囊结石合并胆总管结石效果及临床相关因素。方法：回顾性分析2010年4月-2013年4月笔者所在医院经影像学确诊为胆囊结石合并胆总管结石并经内镜与腹腔镜联合治疗的127例患者的治疗效果，并采用单因素相关分析和Logistic回归分析取石成功及未复发与临床因素的相关性。结果：内镜与腹腔镜联合治疗后，取石成功者占78.74%(100/127)，结石残留者占21.26%(27/127)；未复发者占85.04%(108/127)，复发者占14.96%(19/127)。单因素相关分析发现，取石成功及未复发均与患者年龄、结石数量、结石最大直径、胆总管直径、无胆管扩张、无胆总管扩张、无合并胆管炎或胰腺炎有关；另外，未复发还与取石成功、无黄疸史及无术后并发症有关。Logistic回归分析发现，结石数量、胆总管直径、无胆管扩张、无胆总管扩张、无合并胆管炎是影响取石成功及未复发的独立因素；另外，年龄、无结石残留、无术后并发症亦是影响结石未复发的独立因素。结论：年龄<55岁、结石数量<10个、无结石残留、胆总管直径≥1 cm、无胆管或胆总管扩张、无合并胆管炎、无术后并发症的胆囊结石合并胆总管结石患者内镜与腹腔镜联合治疗效果较好。