胆囊结石合并胆总管结石患者行腹腔镜胆囊切除联合胆总管切开取石T管引流术后结石复发危险因素分析

Risk factors for recurrence of stones after LC combined LCHTD in patients with gallbladder and common bile duct stones

目的探讨胆囊结石合并胆总管结石患者行腹腔镜胆囊切除(LC)联合胆总管切开取石T管引流术(LCHTD)治疗后结石复发的影响因素。方法回顾性分析247例胆囊结石合并胆总管结石患者的临床资料和随访资料,均行LC联合LCHTD治疗。对可能影响术后结石复发的相关因素进行Logistic分析。结果 247例患者中,术后1年累积复发率为2.43%,3年累积复发率为8.10%,5年累积复发率为14.98%。单因素分析显示,年龄、结石数量、胆总管直径、是否行碎石术、胆总管扩张、胆囊管扩张、合并炎症与术后结石复发有关(P<0.05);性别、病程、胆总管结石类型、结石直径与术后复发无相关性(P>0.05)。Logistic多因素回归分析显示,胆总管直径≥1.5 cm、胆总管扩张、胆囊管扩张、合并炎症是术后结石复发的独立危险因素(P<0.05),而结石数量、胆总管扩张、胆囊管扩张与术后结石复发无关(P>0.05)。结论胆囊结石合并胆总管结石患者行LC联合LCHTD治疗后结石复发是多种因素共同作用的结果,应认真评估患者术后复发的风险,并积极采取干预措施以降低术后结石复发率。

Objective To investigate the risk factors for recurrence of stones after LC combined LCHTD in patients with gallbladder and common bile duct stones. Methods The clinical data and follow-up data of 247 patients with gallstone and common bile duct stones were retrospectively analyzed. All the patients were treated with LC combined LCHTD. Logistic analysis was performed to analyze the factors that may influence the recurrence of stones after operation. Results In 247 patients, after 1 years the cumulative recurrence rate was 2. 43%, the 3 year cumulative recurrence rate was 8. 10%, the 5 year cumulative recurrence rate was 14. 98%. Univariate analysis showed that age, number and diameter of common bile duct calculi, lithotripsy, common bile duct, gallbladder, GuaM Kuozhang with inflammation and postoperative recurrence of stones （ P 〈 0. 05 ） ; Gender, duration, type, diameter of common bile duct stones and stone recurrence no correlation （P 〉 0. 05）. Multivariate logistic regression analysis showed, bile duct diameter ≥ 1.5 cm, bile duct, gallbladder duct dilation, inflammation is associated with postoperative recurrence of calculi independent risk factors （ P 〈 0. 05 ）, the number of stones, common bile duct, gallbladder duct and postoperative recurrence of stones （ P 〉 0.05 ）. Conclusion Gallbladder and common bile duct stones were treated by LC and LCHTD treatment after recurrence of stones is the interac- tion of many factors results should be a careful assessment of the risk of recurrence after surgery, and actively take measures to reduce the postoperative recurrence rate of cholecystolithiasis.