腹腔镜联合胆道镜治疗胆总管结石复发预后的临床分析-现代医学

腹腔镜联合胆道镜治疗胆总管结石复发预后的临床分析

单位：1. 首都医科大学附属北京潞河医院普外一病区, 北京 101149;
2. 河北医科大学附属第二医院胆道微创外科, 河北石家庄 050000

分类号：R657.4

出版年·卷·期（页码）：2017·36·第九期（1333-1337）

摘要：

目的：探讨血清CA19-9表达水平与腹腔镜联合胆道镜治疗胆总管结石的复发预后之间的潜在关联。方法：本研究中选取本院就诊接受腹腔镜联合胆道镜治疗胆总管结石的患者100例为研究对象，其中胆总管结石复发患者38例，非复发患者62例；借助回顾性队列原理，对患者血清CA19-9水平同结石复发之间的关联及潜在影响因素进行分析讨论。使用SPSS 17.0软件完成相关统计分析。结果：本研究中，复发组与非复发组患者血清CA19-9水平在手术前后的水平对比以及表达阳性率对比情况发现，结石复发组术前CA19-9水平为（22.36±2.68）μg·ml^-1，非复发组为（20.37±2.97）μg·ml^-1，复发组高于非复发组，P<0.05；手术后一周内检测水平比较提示，复发组CA19-9水平降至（20.33±3.11）μg·ml^-1，非复发组降至为（18.74±3.04）μg·ml^-1，复发组高于非复发组，P<0.01；同时，两组CA19-9水平术后一周内水平均显著低于术前水平，且阳性率也在术后显著降低，P<0.01。多因素Logistics回归分析结果提示，血清CA19-9水平增高的患者发生胆总管结石复发的风险为未增高者的1.428（1.267~1.609）倍，是一个独立的危险因素，P<0.001；出现黄疸、超重肥胖、既往囊炎病史以及现患高血压也均为胆总管结石复发的危险因素，OR值分别为1.410（1.043~1.906），1.095（1.082~1.108），1.095（1.082~1.108）和1.048（1.043~1.054），P<0.05；此外，年龄增高和男性表现为弱保护因素，OR值接近1，分别为0.959（0.953~0.965）和0.770（0.722~0.820），P<0.001。结论：CA19-9水平增高与胆总管结石微创术后复发预后存在关联，同时受到黄疸情况等因素的影响。

Object: To investigate the relationship between the expression of serum CA19-9 and the prognosis of choledocholithiasis treated by laparoscopy combined with choledochoscopy. Methods: In this study, 100 patients with choledocholithiasis underwent laparoscopy combined with choledochoscopy were recruited and 38 patients with recurrence of choledocholithiasis and 62 patients with non-recurrence of choledocholithiasis were recruited. According to the retrospective cohort principle, the level of CA19-9 in patients with recurrence and the relationship between the potential impact factors. SPSS 17.0 software was used to complete the relevant statistical analysis. Results: The levels of CA19-9 in recurrent group and non-relapse group before and after operation were significantly higher than that in recurrence group (22.36±2.68 μg·ml^-1, (20.37±2.97 μg·ml^-1). The level of CA19-9 in the relapse group was lower than that in the non-relapse group (P<0.05). The level of CA19-9 in the relapse group decreased to 20.33 ±3.11 μg ·ml^-1, (18.74±3.04 μg·ml^-1), recurrence group was higher than that of non-recurrence group (P<0.01). Meanwhile, CA19-9 level in both groups was significantly lower than preoperative level, and the positive rate was significantly lower, P & lt; 0.01. Multivariate logistic regression analysis showed that the risk of recurrence of choledocholithiasis was 1.428 (1.267~1.609) times higher than that of patients with elevated serum CA19-9 level, which was an independent risk factor, P<0.001; jaundice, Overweight and obesity, previous history of bursitis and hypertension were also risk factors for recurrence of common bile duct stones. The OR values were 1.410 (1.043~1.906), 1.095 (1.082~1.108), 1.095(1.082~1.108) and 1.048 (OR=1.043~1.054), P<0.05). In addition, age increased and men showed weak protective factors, OR values were close to 1, 0.959 (0.953~0.965) and 0.770 (0.722~0.820), respectively. Conclusion: The increase of CA19-9 level is associated with the prognosis of recurrence for choledocholithiasis, and is influenced by jaundice and otherpotential factors.

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