총담관담석의 내시경 치료 후 잔여 담석의 위험인자
Risk Factors for the Presence of Residual Bile Duct Stones after Endoscopic Treatment of Stones of the Common Bile Duct
Background/Aims: Stones remaining after endoscopic treatment of common bile duct (CBD) stones may evolve into recurrentCBD stones or serve as nuclei for the growth of new CBD stones. The aim of the present study was to identify risk factors for thepresence of residual stones after endoscopic treatment of CBD stones. Methods: We performed a retrospective case-control study; 55 patients with residual stones were enrolled as the case group and281 patients without such stones served as a control group. We collected information on age, sex, stone characteristics, laboratoryfindings, the presence/absence of a periampullary diverticulum, use of mechanical lithotripsy, use of (single-procedure) endoscopicpapillary balloon dilatation (EPBD), presence/absence of multiple CBD stones, CBD stone size, CBD stone diameter, whetherCBDs were associated with gall bladder stones, and histories of prior cholecystectomy and cholecystectomy performed afterendoscopic treatment. Results: Upon univariate analysis, mechanical lithotripsy, single-procedure EPBD, the presence of multiple CBD stones (morethan four), and CBD stone diameter greater than 1 cm were risk factors for the presence of residual stones. Upon multivariateanalysis, single-procedure EPBD (odds ratio [OR], 3.174; 95% confidence interval [CI], 1.68-6.00; p = 0.000), and more than fourCBD stones (OR, 2.459; 95% CI, 1.24-4.86; p = 0.010), were significant risk factors for the presence of residual stones. Conclusions: Single-procedure EPBD and the presence of more than four CBD stones were independent risk factors for thepresence of residual stones. Particular care, featuring meticulous inspection, is necessary when treating patients with these riskfactors. A second procedure, endoscopic retrograde cholangiopancreatography, may be required.
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