Background

The latest guidelines recommended that common bile duct stones (CBDSs) should be removed, preferably endoscopically, regardless of the presence of symptoms or complications. However, the removal of CBDSs may not be feasible in very old patients or those with co-morbidities. In these cases, it is important to understand the risk factors for the development of CBDSs-related complications to decide whether or not to treat high-risk patients. Herein, we aimed to identify the risk factors for the development of complications after the diagnosis of CBDSs.

Methods

The medical records of patients with CBDSs between October 2005 and September 2019 were retrospectively analyzed. All patients with radiologically-diagnosed CBDSs, including those who received treatment and those who did not, were analyzed.

Results

A total of 634 patients were included and 95 (15.0%) patients had CBDS-related complications during the mean follow-up period of 32.6 months. Forty-four (6.9%) high-risk patients remained asymptomatic and did not receive treatment during the follow-up period. In multivariate analyses, size of CBDSs ≥ 5 mm and no treatment within 30 days were independent risk factors for the development of complications. The spontaneous passage of CBDSs was proved radiologically in 9 out of 81 (11.1%) patients within 30 days.

Conclusions

It is recommended treating CBDSs within 30 days from the diagnosis, even in high-risk patients, especially if the size is larger than 5 mm.

中文翻译：

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胆总管结石并发症的危险因素分析

背景

最新指南建议，无论是否存在症状或并发症，都应切除胆总管结石 (CBDS)，最好是通过内窥镜检查。然而，对于非常年长的患者或有合并症的患者，去除 CBDS 可能是不可行的。在这些情况下，重要的是要了解 CBDS 相关并发症发展的风险因素，以决定是否治疗高危患者。在此，我们旨在确定 CBDS 诊断后发生并发症的风险因素。

方法

回顾性分析 2005 年 10 月至 2019 年 9 月 CBDS 患者的病历。分析了所有经放射学诊断为 CBDS 的患者，包括接受治疗的患者和未接受治疗的患者。

结果

在 32.6 个月的平均随访期内，共纳入 634 名患者，95 名（15.0%）患者出现 CBDS 相关并发症。44 名 (6.9%) 高危患者在随访期间保持无症状且未接受治疗。在多变量分析中，CBDS ≥ 5 mm 和 30 天内未治疗是并发症发生的独立危险因素。在 30 天内，81 名患者中有 9 名（11.1%）通过放射学证明 CBDS 自发通过。

结论

建议在诊断后 30 天内治疗 CBDS，即使是高危患者，尤其是大小大于 5 毫米的患者。