| Purpose:To explore related risk factors of postoperative recurrence after ERCP treatment., the relevant clinical indicators of patients who were treated by means of Endoscopic Retrograde Cholangiopancretography between September 2011 and September 2013 in digestive internal medicine of Wan Nan Medical College yijishan hospita in Wuhu Anhui Province were retrospectively reviewed.Subjects and Methods: Collected clinical datas of patients with common bile duct stones and postoperative recurrence after ERCP treatment in digestive internal medicine of Wan Nan Medical College yijishan hospital between September 2011 and September 2013. Sorting datas and creating a small database of general situation and related factors of patients, including patients’ hospitalized number, age,gender, height, weight and whether or not combining with gallbladder stones, whether or not combining with periampullary diverticulum, whether or not had history of biliary tract surgery before, the diameter of common bile duct, the size of the nipple incision, the size of the stone, and other relevant information. Selecting the patients included in this analysis according to the following inclusion criteria and exclusion criteria, then selected patients included in the analysis into two group, the relapsed group and the group without stone recurrence after ERCP. Two groups of patients’ relevant clinical indicators werestatistically analyzed. The correlation factors which have statistically significant will be introducing into the Logistic regression analysis. Here are the inclusion criteria 、exclusion crireria and calculi recurrence criteria: Inclusion criteria:(1) Age 18 or more;(2) Abdominal ultrasound 、CT 、MRCP,etc confirmed the diagnose of stones;(3)There was no ERCP surgery before. Exclusion criteria:(1)Patients with intrahepatic bile duct stone before or found in the operation;(2)The patients combined with severe liver diseases, such as cirrhosis, liver failure;(3)The patients combined with severe blood system diseases and blood coagulation dysfunction;(4)Women who were pregnant and can not accept the common bile duct radiography;(5)Patients who combined with gallbladder, bile duct and duodenal papilla tumor or congenital bile duct cysts;(6)Patients after Billroth II gastrectomy. Calculi recurrence criteria: Angiography showed that the common bile duct stones had been exhausted after the treatment of ERCP, abdominal ultrasound 、CT or ERCP confirmed the recurrence of the stone six months later.Results: 209 cases of patients were retrospectively analyzed according to the inclusion and exclusion criteria. 4 patients among them were lost contact because of the changing telephone number, the lost to flow-up rate is 1.9%.There were 28 cases of patients with recurrence of common bile duct calculi and 177 cases of patients without recurrence of common bile duct calculi. 1、Age: The age of the patient involved in this analysis distributed between 19-89, with an average age of 61.01±15.21. The average age of the relapsed group was 63.76 ± 13.01 and the average age of the not relapsed group was 60.57 ± 15.52, there was nostatistically significant difference between them(P > 0.05). 2、Gender: The relapsed group was consisted of 11 cases of men(11/28)and 17 cases of women(17/28), whether the not relapsed group was consisted of 70 cases of men and 107 cases of women. The Chi-square test showed that there was no statistically significance between the two groups(P > 0.05). 3 、 BMI: According to the formula of body mass index(BMI) :BMI = weight(Kg)/height(m)2,calculating the body mass index of patients in each group. The average body mass index of the relapsed group was 21.88±3.14, and the average body mass index of the group without recurrence was 22.42 ±2.70, there was no statistically significant difference between the two groups(P>0.05). 4、History of biliary tract surgery : Asking for details of any preoperative biliary tract surgery, 17 cases(17/28)of patients in the relapsed group had one or more history of biliary tract surgery before, whether in the group which not relapsed there were 96 cases(96/177)..Compared patients who had biliary tract surgery before and patients who had the recurrence of commom bile duct stone after ERCP, there was no statistical significance(P > 0.05). 5、Common bile duct diameter: The two groups of patients can be divided into 1.5 cm or higher and small than 1.5 cm two small groups respectively, by a common bile duct diameter of 1.5 cm.17 cases(17/28) of patients with common bile duct diameter of 1.5 cm or more in the relapsed group, in the not relapsed group there were 56 patients(56/177) with common bile duct diameter of 1.5 cm or more. Comparing the two groups of the diameter of common bile duct and the calculi recurrence after ERCP treatment, the diameter of 1.5 cm or more has a statistical significance with the postoperative recurrence after ERCP(P < 0.05). 6、Nipple incision: By a nipple incision of 1.0cm,the two groups can be divided into large incision(nipple incision 1.0 cm or higher)group and small incision(nipple incision < 1.0 cm) group. 13 patients(13/28) with nipple incision 1.0cm or higher in therelapsed group,48 patients(48/177)in the group without recurrence. Comparing the size of nipple incision and the recurrence of common bile duct calculi after ERCP of the two groups, results show that the size of nipple incision equaling to 1.0cm or higher has a statistical significance with the recurrence of common bile duct calculi after ERCP(P < 0.05). 7、Combined with periampullary diverticulum: 11 cases(11/28) of patients combined with periampullary diverticulum in the group relapsed,35 cases(35/177) in the group without recurrence. Comparing patients who combined with periampullary diverticulum and the recurrence of common bile duct calculi after ERCP of the two groups, results show that patients mergered of periampullary diverticulum has a statistical significance with the postoperative recurrence after ERCP(P < 0.05). 8、Combined with gall calculi : According to the abdominal ultrasound or other check way preoperatively, 8 patients(8/28)combined with gallstones in recurrent group, 21 cases(21/177) of patients combined with gall calculi in the group without recurrence, compared two groups whether patients combined with gallbladder calculi and patients with postoperative recurrence after ERCP treatment, the result shows that combined with gallstones has a statistical significance with the postoperative recurrence after ERCP(P < 0.05). 9、Stone diameter: 17 cases(17/28)of patients with stone diameter of 1.0 cm or higher in recurrent group,70 cases(70/177)of patients with stone diameter of 1.0 cm or higher in the group without recurrence, compared two groups of the size of stone diameter and the recurrence of common bile duct stones after ERCP treatment, the result shows that the size of stone diameter equaling to 1.0 cm or more has a statistical significance with the postoperative recurrence after ERCP(P < 0.05). 10、Stone number: 9 cases(9/28) of patients with single stone and 19 cases(19/28)of patients with stone number of 2 or more pieces in the recurrent group. In the group without recurrence there are 112 patients(112/177)with single stone and 65 patients(65/177)with the stone number of 2 or more pieces. Compared two groups of the stone quantity and the recurrence of common bile duct stones after ERCP treatment, the result shows that the number of 2 or more pieces of common bile duct stones has a statistical significance with the postoperative recurrence after ERCP(P < 0.05). Introducing the statistically significant factors associated with the recurrence of common bile duct stones above into the Logistic regression analysis, the result shows that combined with periampullary diverticula,nipple incision(with the incision 1.0cm or more),common bile duct dilation(with the diameter 1.5cm or more), stone numbers 2 or more are risk factors of the recurrence of common bile duct stones after ERCP.Conclusion:The merger of periampullary diverticulum, big nipple incision(nipple incision 1.0 cm or more), the expansion of common bile duct(diameter 1.5 cm or more) and frequent stone(stone number 2 or more) can be considered risk factors for the postoperative recurrence. |
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