胆囊结石行腹腔镜联合胆道镜保胆取石术后随访资料的临床分析(附644例报告)

The clinical follow-up data analysis of 644 patients with cholecystolithiasis after laparoscopic combined with choledochoscopic gallbladder-preserving cholelithotomy

目的:探讨腹腔镜联合胆道镜保胆取石术治疗胆囊结石的临床效果,调查术后复发情况,分析术后复发的影响因素。方法:回顾性收集644例胆囊结石患者的临床资料,均行腹腔镜联合胆道镜保胆取石术。记录患者的人口学资料及疾病相关资料,随访术后情况、复发情况。以术后是否复发作为因变量,通过多因素Logistic回归分析研究术后复发的危险因素。结果:患者均顺利完成手术,术后未出现胆道损伤、切口感染等并发症;共601例患者获得随访,其中29例患者出现复发,复发率为4.83%;复发组结石数量≥3、有急性发作史患者的比例显著高于未复发组,差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示,急性发作史及结石数量是腹腔镜联合胆道镜保胆取石术后复发的危险因素,OR值分别为4.305、1.893。结论:腹腔镜联合胆道镜保胆取石术治疗胆囊结石安全、有效,但仍存在一定的复发风险,有急性发作史及结石数量≥3的患者应慎重选择。

Objective： To explore the effect of laparoscopic combined with choledochoscopic gallbladder-preserving cholelithotomy in the treatment of cholecystolithiasis,to investigate the postoperative recurrence and analyze the influence factors of postoperative recurrence. Methods： The clinical data of 644 patients with cholecystolithiasis were collected,they were treated by laparoscopic combined with choledochoscopic gallbladder-preserving cholelithotomy. The patient’s demographic information and disease related information were recorded,they were all followed up and recorded the postoperative recurrence. Whether with postoperative recurrence was set as dependent variable,the risk factors for postoperative recurrence were analyzed with multiple factors Logistic regression analysis. Results： All operations were successfully completed,there were no postoperative complications such as biliary injury or infection of incision. A total of 601 patients received follow-up,29 cases of recurrence were found,the recurrence rate was 4. 83%. The number of patients whose stones were more than 3 and having a history of acute attack in recurrence group were more than no recurrence group,the difference was statistically significant（ P 〈 0. 05）. Multivariable Logistic regression analysis results showed that the number of stones and a history of acute onset were risk factors for recurrence after laparoscopic combined with choledochoscopic gallbladder-preserving cholelithotomy,the OR value were 4. 305 and 1. 893 respectively. Conclusions： Laparoscopic combined with choledochoscopic gallbladder-preserving cholelithotomy is safe and effective,but there are still some risks of recurrence,patients with a history of acute attack and the stone number≥3 should be chosen carefully.