背景:胆石病在西方社会极为普遍,老年人胆总管(CBD)结石合并胆石症的患病率显着增加。不同的变异会影响这种病理实体的治疗,比如石头的起源,他们的位置和数量,患者的合并症,撞击,和石器的大小,后者是一个独立的预测因素。在大多数情况下,胆总管结石可以通过内镜逆行胰胆管造影术(ERCP)解决;然而,在复杂的情况下,如巨大胆总管结石(GC),先进的外科,内窥镜,和经皮技术需要去除胆结石。主要目的是确定GC与原发性胆总管结石(PC)之间是否存在相关性。次要目标包括描述GC的内窥镜表征。
方法:本研究为横断面单中心研究。研究人群包括国家工人社会保障和服务研究所(ISSSTE,西班牙语为首字母缩写)地区医院的患者,莱昂,瓜纳华托,直接属于这个中心或被提及,谁需要由普外科/内窥镜服务的医疗护理与胆总管结石的诊断,在2017年1月至2022年12月期间。Kolmogorov-Smirnov检验用作正态检验。如果数据分布是正态分布,则定量变量报告为平均值和标准偏差,如果发现异常分布,则与中位数和四分位数范围内的数据表达相反。此外,定性变量以频率或百分比报告。进行卡方检验作为独立性检验。显著性水平为95%置信区间(p值0.05)。用比值比(OR)计算效应大小。
结果:在总共177名患者中,33对应于PC(18.6%),144人属于继发性胆总管结石(SC)组(81.4%)。同样,关于石器的尺寸,59例(33.3%)患者出现GC,118例(66.7%)患者出现非GC。在59例GC患者中,女性36人(61%),男性23人(39%)。关于年龄,分布如下:平均62±12年,最小值为29年,最大值为88年。用于确定变量之间是否存在相关性的非参数检验是皮尔逊卡方,其值为60.509,p<0.001,表明PC和GC之间存在相关性。用OR证实和定义了效应大小,值为39.6(置信区间(CI)11.308-139.069)。
结论:GC与PC之间存在显着相关性,发现机械碎石术是最有效的GC初始提取方法;此外,发现更高的完全内窥镜分辨率,以及与手术相关的并发症,这与文学形成鲜明对比。将本研究中揭示的信息用作这方面未来研究的里程碑将是很有趣的。
BACKGROUND: Gallstone disease is extremely prevalent in Western society, and the prevalence of common bile duct (CBD) stones with concomitant cholelithiasis increases significantly in the elderly. Different variants influence the treatment of this pathological entity, such as the origin of the stones, their location and quantity, comorbidities of the patient, impaction, and size of the lithos, the latter being an independent predictive factor. In most situations, choledocholithiasis can be resolved with endoscopic retrograde cholangiopancreatography (ERCP); however, in complex cases, such as giant choledocholithiasis (GC), advanced surgical, endoscopic, and percutaneous techniques are required to remove gallstones. The main objective was to determine if there is a correlation between GC and primary choledocholithiasis (PC). The secondary objective consisted of describing the endoscopic characterization of GC.
METHODS: The present study is a cross-sectional and single-center study. The study population consisted of patients of the Institute for Social Security and Services for State Workers (ISSSTE by its acronym in Spanish) Regional Hospital, León, Guanajuato, belonging directly to this center or referred, who required medical attention by the General Surgery/Endoscopy Service with the diagnosis of choledocholithiasis, during the period between January 2017 and December 2022. The Kolmogorov-Smirnov test was used as the normality test. Quantitative variables were reported as mean and standard deviation if the data distribution was normal, in contrast with the expression of data in the median and interquartile range if an abnormal distribution was found. Moreover, the qualitative variables are reported in frequencies or percentages. The Chi-square test was performed as the independence test. The significance level was a 95% confidence interval (p-value 0.05). The effect size was calculated with the odds ratio (OR).
RESULTS: Out of a total of 177 patients, 33 corresponded to PC (18.6%), and 144 belonged to the secondary choledocholithiasis (SC) group (81.4%). Likewise, regarding the dimensions of the lithos, 59 patients (33.3%) presented GC and 118 (66.7%) presented non-GC. Among the 59 patients with GC, 36 were female (61%) and 23 were male (39%). Regarding age, the distribution was as follows: mean 62 ± 12 years, with a minimum value of 29 and a maximum of 88 years. The non-parametric test used to determine the existence or not of a correlation between the variables was Pearson\'s Chi-square, whose value was 60.509, with a p < 0.001, demonstrating the presence of a correlation between PC and GC. The effect size was corroborated and defined with the OR, whose value was 39.6 (confidence interval (CI) 11.308-139.069).
CONCLUSIONS: There is a significant correlation between GC and PC, and it was found that mechanical lithotripsy was the most performed initial extraction method for GC; furthermore, a higher rate of complete endoscopic resolution was found, as well as no complications related to the procedure, which contrasts with the literature. It would be interesting to use the information revealed in the present study as a landmark in future research in this regard.