Analysis Of Risk Factors For Recurrence Of Common Bile Duct Stones After ERCP

Background and Objectives:In recent years,the development of endoscopic retrograde cholangiopancreatoraphy(ERCP)has made choledocholithiasis a new field of treatment.ERCP has quickly become the first choice for the treatment of common bile duct stones.At present,some patients have recurrence of common bile duct stones after taking stones,and in recent years,studies have shown that the recurrence rate of common bile duct stones is increasing year by year.Recurrence of common bile duct stones often requires multiple times to take stones from the common bile duct,and multiple stone removals bring physical pain and economic pressure to the patients.The purpose of this study was to analyze the risk factors for recurrence of common bile duct stones after ERCP stone removal,from age,gender,number of common bile duct stones,common bile duct diameter,papillary sphincter incision,periampullary diverticulum,bile duct stent implantation,gallbladder Retrospective analysis of the status and other aspects,better understanding of the recurrence of calculi after ERCP and risk factors associated with recurrence,theoretically can better predict the cause of recurrence of choledocholithiasis after ERCP,thus early detection of patients with risk factors Be prepared to reduce the recurrence of common bile duct stones after ERCP,so that these patients benefit.Method:From January 2012 to December 2016,ERCP was performed in the Jiaxing Second Hospital due to common bile duct stones.The intraoperative angiography confirmed the presence of common bile duct stones.The final 835 patients who underwent calculi were followed up.The follow-up methods included: reviewing the electronic case records of patients admitted to the hospital,imaging data during admission,telephone enquiries on recurrence and treatment,re-admission treatment and imaging data.The clinical data of the included subjects were retrospectively analyzed,and the time of recurrence of common bile duct stones,the number of recurrences,and imaging data were recorded during follow-up.Further analysis of related factors was performed by univariate analysis,and statistically significant variables were included in COX multivariate regression analysis to analyze the independent risk factors for recurrence of common bile duct stones after ERCP.Result:Of the 835 patients who received definitive follow-up and met the inclusion criteria,622 had recurrence of 64 of the 622 patients,with a recurrence rate of 10.2%.Among the relapsed patients,34 were male and 30 were female.The average age of male recurrence group was60.50 years old,and the average age of female recurrence group was 59.66 years old.14 cases relapsed more than 2 times.Of the 14 patients who had recurrence more than 2 times,5 were male and 9 were female.In the follow-up patients,the general data of the chi-square test showed that the common bile duct diameter,stone size,bile duct stent implantation,nipple sphincter incision,ampullary diverticulum,and stone number were statistically different between the recurrent group and the non-recurrent group.(P<0.05).Univariate analysis results: common bile duct diameter,implantation of bile duct stent,incision of nipple sphincter,number of stones,diverticulum around the ampulla had an effect on stone recurrence(P<0.05),and age,gender,stone size,gallbladder Whether resection and ERCP times had no effect on the recurrence of stones(P>0.05).Statistically significant factors were analyzed by multivariate COX regression: common bile duct diameter,bile duct stent implantation,duodenal papillary diverticulum,and sphincter sphincter incision,an independent factor for recurrence after ERCP,RR less than 1 is the protective factor,and the relevant statistics in the common bile duct diameter(RR=8.08,95% CI: 4.158-15.424,P=0.000);bile duct stent implantation(RR=3.947,95% CI: 1.718-9.071,P=0.001);duodenal papillary diverticulum(RR=3.947,95% CI: 1.454-5.273,P=0.002);medial incision in nipple incision(RR=3.547,95% CI: 1.432-8.785),P = 0.006);small incision in the sphincter incision mode(RR = 1.869,95% CI: 0.994-3.616,P = 0.052).Conclusion:Through retrospective analysis and analysis,it is suggested that: 1.The diameter of the common bile duct,the implantation of the bile duct stent,the sphincter sphincter incision,the presence of diverticulum in the duodenal papilla,and the number of stones are related to the recurrence of common bile duct stones after ERCP;Multivariate analysis showed that the diameter of the common bile duct was ≥15mm,the incision of the duodenal papillary sphincter,the placement of the bile duct stent,and the duodenal papillary diverticulum were independent risk factors for the recurrence of common bile duct stones after ERCP.