内镜逆行胰胆管造影术在不同类型困难胆管结石中的诊疗体会

Experience in diagnosis and treatment of different types of difficult bile duct calculi by endoscopic retrograde cholangiopancreatography

摘要:

目的 探讨内镜逆行胰胆管造影术（ERCP）在胆总管巨大结石、胆总管多发结石和消化道重建术后患者中的治疗效果，分析手术失败的原因及其影响因素。方法 回顾性分析2016年－2019年解放军联勤保障部队第九〇九医院收治的146例经ERCP治疗的困难胆管结石患者的临床资料。其中，A组（n = 43）结石直径 > 15 mm，B组（n = 21）结石数量 > 10枚，C组（n = 82）行上消化道重建。根据ERCP取石是否成功，分为取石成功组（n = 106）和取石失败组（n = 40），比较两组患者ERCP操作时间、插管次数、取石成功率、结石残余率、不良事件发生率、结石直径和消化道重建方式等，采用单因素和多因素分析困难胆管结石患者ERCP手术失败的原因。结果 3组患者操作时间、平均插管次数、结石直径、残余结石和激光碎石比较，差异均有统计学意义（P < 0.05）；单因素分析结果显示：困难胆管结石患者中，ERCP取石成功组与取石失败组ERCP操作时间、插管次数、结石数目、消化道重建和是否首次ERCP比较，差异均有统计学意义（P < 0.05）；多因素分析结果显示：ERCP操作时间、插管次数、多发结石和消化道重建是困难胆管结石患者ERCP取石失败的危险因素（P < 0.05）。结论 ERCP取石在困难胆管结石患者中安全、可行，但需根据个体情况制定合理的治疗方案。

Abstract:

Objective To investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) in patients with different types of difficult bile duct stones. Then analyze the causes and influencing factors of surgical failure.Methods The clinical data of 146 patients with difficult cholangiolithiasis treated by ERCP from 2016 to 2019 were retrospectively analyzed. Group A (n = 43) with calculi diameter > 15 mm, Group B (n = 21) with the number of calculi > 10, Group C (n = 82) with upper digestive tract reconstruction. According to the success of ERCP stone extraction, it can be divided into successful stone extraction group (n = 106) and failed stone extraction group (n = 40). ERCP operation time, intubation times, success rate of stone extraction, residual stone rate, incidence of adverse events, stone diameter and digestive tract reconstruction were compared. Univariate and multivariate analysis were used to analyze the causes of ERCP failure in patients with difficult bile duct stones.Results There were statistically significant differences in operation time, average number of intubation, stone diameter, residual stone incidence and laser lithotriptomy among the three groups (P < 0.05). Univariate analysis showed that there were statistically significant differences in ERCP operation time, intubation times, number of stones, digestive tract reconstruction and whether it was the first ERCP between the successful ERCP group and the failed group in patients with difficult bile duct stones (P < 0.05). Multivariate analysis showed that ERCP operation time, intubation times, multiple calculi and digestive tract reconstruction were risk factors for ERCP stone removal failure in patients with difficult bile duct stones (P < 0.05).Conclusion ERCP lithotomy is safe and feasible in patients with difficult bile duct calculi, but a reasonable treatment plan should be formulated according to the individual situation of patients.