239例腹腔镜联合胆道镜保胆取石术后3年临床随访分析

The clinical analysis of combined laparoscopic and choledochoscopiclithotomy with gallbladder preservation during three years of follow-up after surgery:report of 239 cases

目的了解腹腔镜联合胆道镜保胆取石术治疗胆囊结石患者术后复发情况,探讨腹腔镜联合胆道镜保胆取石术治疗胆囊结石安全性、有效性及复发的相关因素。方法收集2009年2月-2010年2月兰州军区乌鲁木齐总医院符合标准239例腹腔镜联合胆道镜保胆取石术住院患者临床资料并进行随访。统计分析术后胆囊结石复发率及复发的相关因素。结果共随访患者198例,随访率82.8%(198/239),随访时间最短为36个月,最长为48个月,总复发率为5.1%(10/198),单发胆囊结石及多发胆囊结石复发率分别为1.5%、3.5%;单因素分析结果显示多发胆囊结石、是否服用熊去氧胆酸胶囊与胆囊结石复发明显相关,差异有显著性(χ2值分别=10.042、7.589;P值分别=0.002、0.006)。多因素结果显示多发胆囊结石为腹腔镜联合胆道镜保胆取石术后结石复发的独立影响因素。结论通过3年的随访观察,腹腔镜联合胆道镜保胆取石术后3年复发率较低,是一种安全、有效的手术方式,多发胆囊结石、是否服用熊去氧胆酸胶囊与结石复发密切相关,特别是多发胆囊结石对于术后结石复发具有重要意义。

[ Objective ] To investigate recurrence of gallstones after laparoscopic and choledochoscopiclithotomy combined with gallbladder preservation, and to explore the safety and effectiveness of the modus operandi and related to post-operative recurrence. [Methods] From February 2009 to February 2010, in Urumqi General Hospital of Lanzhou Military Region, the clinical data of 239 hospitalized patients who underwent laparoscopic and choledochoseopiclithotomy combined with gallbladder preservation and met the study criteria were collected and followed up. The recurrence of gallstones in post-operative and factors related to recurrence were analyzed. [Results] A total of 198 post-operative patients were successfully followed up, the follow-up rate was 82.8% （198/ 239）. The shortest follow-up period was 36 months and the longest was 48 months. The total recurrence of solitary and multiple gallstones were 1.5%, 3.5%. Monofactorial analysis showed multiple gallstones and whether oral ursodeoxycholic acid capsules were significantly related with the recurrence of gallstones in post-operative, and the difference was statistical significant （P 〈0.05）. Multivariate Cox regression analysis showed multiple gallstones were the independent factor for the recurrence of gallstones in post-operative. [ Conclusion ] Through the observation of 3 years of follow-up, the recurrence rate of combined laparoscopic and choledochoscopiclithotomy with gallbladder preservation is low.It is a kind of safe effective surgical approach. Multiple gallstones, whether oral ursodeoxycholic acid capsules were factors related to recurrence rate, especially the multiple gallstones were significant.