超声内镜检查术在胃大部切除术后胆总管结石患者中的应用分析

Analysis of endoscopic ultrasonography in patients with choledocholithiasis after subtotal gastrectomy

摘要:

目的 探讨胃大部切除术后胆总管结石患者行超声内镜检查术（EUS）的价值和意义。方法 回顾性分析2020年－2021年该院收治的83例远端胃大部切除术后因胆管总结石行内镜逆行胰胆管造影术（ERCP）的患者的临床资料。根据是否行EUS分为观察组（n = 40）和对照组（n = 43），观察组采用EUS+ERCP，对照组采用ERCP，分析观察组EUS诊断胆总管结石的准确率，对比两组患者ERCP成功率、插管次数、操作时间、不良事件发生率、透视时间和总辐射剂量，采用单因素和Logistic多因素分析影响入组患者ERCP手术成功率的因素。结果 EUS诊断准确率（90.00%）高于磁共振胰胆管成像（MRCP）（79.52%），但差异无统计学意义（χ² = 2.10，P = 0.203）；观察组手术时间和透视时间明显短于对照组，插管次数和辐射剂量明显少于对照组，取石成功率高于对照组，差异均有统计学意义（t = -14.64、t = -3.64、t = -4.33、t = -8.64和χ² = 4.60，P < 0.05）；单因素分析发现，EUS、腹腔镜手术和多发结石是影响ERCP取石成功率的因素（χ² = 16.32、χ² = 12.22和χ² = 7.47，P < 0.05）；Logistic多因素分析发现，EUS和腹腔镜手术是影响ERCP取石成功率的独立危险因素（95%CI：0.573～1.215，95%CI：0.958～1.969）。结论 对于胃大部切除术后胆总管结石患者，ERCP取石前行EUS，可以减少手术时间，提高取石成功率，具有一定的临床意义。

Abstract:

Objective To investigate the value and significance of endoscopic ultrasonography (EUS) in patients with choledocholithiasis after subtotal gastrectomy.Methods A retrospective analysis was performed on the clinical data of 83 patients with endoscopic retrograde cholangiopanchography (ERCP) after distal subtotal gastrectomy from 2020 to 2021. According to whether or not EUS, they were divided into observation group (n = 40) and control group (n = 43). The accuracy of EUS diagnosis for common bile duct stones in the observation group was analyzed, and the ERCP success rate, intubation times, operation time, incidence of adverse events, fluoroscopy time and total radiation measurement were compared between the two groups. The factors influencing the success of ERCP operation in the enrolled patients were analyzed by univariate and Logistic multivariate factors.Results The diagnostic accuracy of EUS (90.00%) was higher than that of magnetic resonance cholangiopancreatgraphy (MRCP) (79.52%), and the difference was not statistically significant (χ² = 2.10, P = 0.203). The operation time and fluoroscopy time of the observation group were shorter than those of the control group, intubation times and radiation dose of the observation group were less than those of the control group, and the success rate of stone extraction was higher than that of the control group, the differences were statistically significant (t = -14.64, t = -3.64, t = -4.33, t = -8.64, χ² = 4.60, P < 0.05). Univariate analysis showed that EUS, laparoscopic surgery and non-single stones were influencing factors of ERCP stone extraction success (χ² = 16.32, χ² = 12.22, χ² = 7.47, P < 0.05). Multivariate Logistic analysis showed that EUS and laparoscopic surgery were independent factors influencing the success of ERCP stone extraction (95%CI = 0.573~1.215, 95%CI = 0.958 ~ 1.969).Conclusion For patients with choledocholithiasis after subtotal gastrectomy, EUS examination before ERCP can reduce the operation time and improve the success rate of choledocholithiasis, which may have clinical significance.