胆总管结石微创切开取石术后复发的危险因素分析

Analysis of risk factors for common bile duct stones recurrence after minimally invasive lithotomy

目的分析胆总管结石微创切开取石术后复发的危险因素。方法回顾性分析2017年1月-2019年4月在本院实施微创切开取石术的患者纳入182例,术后随访12个月,观察纳入者术后复发率;归纳可能影响患者复发的因素,并进行Logistic多元回归分析。结果复发率为19.23%,其中随访10-12个月内复发占比最高,为54.29%;复发组老年人、合并甲减、合并高脂血症、以胆色素为主的混合结石、壶腹周围憩室、胆汁细菌培养阳性、胆总管直径>1.5 cm、胆囊管扩张占比均高于未复发组(P<0.05),均为术后复发的危险因素(P<0.05);复发组术后T管引流、术后排石辅助治疗、遵医嘱调整饮食、遵医嘱康复锻炼占比均低于未复发组(P<0.05),均为术后复发的保护因素(P<0.05)。结论胆总管结石微创切开取石术后有复发风险,且老年人、合并甲减等均是其危险因素,术后T管引流、术后排石辅助治疗等均是其保护因素。

Objective To analyze the risk factors of recurrence of common bile duct stones after minimally invasive lithotomy.Methods The data of 182 patients with choledocholithiasis who underwent minimally invasive lithotomy in our hospital from January2017 to April 2019 were reviewed.All patients were followed up for at least 12 months,and the recurrence rate was counted.The factors that may affect the recurrence of the patients were summarized and analyzed by logistic multiple regression.Results The recurrence rate was 19.23%,and the highest rate was 54.29%within 10-12 months of follow-up;The elderly,hypothyroidism,hyperlipidemia,mixed stones mainly composed of bile pigment,periampullary diverticulum,positive bile bacteria culture,common bile duct diameter>1.5 cm,and the proportion of cystic duct expansion in the recurrent group were higher than those in the non-recurrent group(P<0.05),which were all risk factors for postoperative recurrence(P<0.05);The proportion of postoperative T-tube drainage,postoperative stone adjuvant treatment,diet adjustment and rehabilitation exercise in the relapse group were lower than those in the non-relapse group(P<0.05),which were protective factors for postoperative recurrence(P<0.05).Conclusion There is a risk of recurrence of common bile duct stones after minimally invasive incision,and the elderly,combined hypothyroidism and so on are risk factors,postoperative T-tube drainage,postoperative adjuvant treatment of stones and so on are its protective factors.