胆总管结石微创手术后反复复发的相关因素分析

Analysis of related factors of recurrent recurrence after minimally invasive surgery for choledoch-olithiasis

目的 研究胆总管结石微创手术后反复复发的危险因素。方法 随访调查2010年5月至2014年4月于本院行胆总管结石微创手术的150例患者的临床资料,随访时间为2~5年,其中136例患者随访成功,将其中术后反复复发（≥2次）的患者36例纳入研究组,采用随机数表法在剩余100例患者中选取40例（胆总管结石微创手术后反复复发1次或未出现复发者）纳入对照组。比较两组患者的临床资料,并对胆总管结石微创手术后反复复发的相关因素进行分析。结果 两组患者结石数量、结石大小以及胆总管直径等比较差异均无显著性（P〉0.05）。单因素分析显示：胆道手术史（OR=5.011,β=1.612）、乳头旁憩室（OR=4.142,β=1.421）、胆总管夹角（OR=14.315,β=2.661）、胆囊切除史（OR=1.736,β=3.143）是胆总管结石微创手术后反复复发的相关因素。多因素分析结果显示,有乳头旁憩室（β=1.243,Waldχ~2=6.43,P=0.011）、胆总管夹角〈45°（β=2.548,Waldχ~2=8.56,P=0.003）、有胆道手术史（β=1.788,Waldχ~2=11.779,P=0.001）是胆总管结石微创手术后反复复发的危险因素。结论 胆道手术史、乳头旁憩室以及胆总管夹角是影响胆总管结石患者微创手术后多次复发的独立危险因素,临床上应对此类患者进行全方位的诊断治疗,以期降低胆总管结石微创手术后反复复发风险。

Objective To study the related factors of recurrence after minimally invasive surgery for choledocholithiasis. Method The clinical data of 150 patients with choledocholithiasis treated in our hospital from May 2010 to April 2014 were followed up for 2 to 5 years, of which 136 patients were successfully followed up,36 patients who repeated postoperative recurrence （ ≥2） were enrolled into study group, in the remaining 100 patients selected 40 patients as control group by random number table method. The clinical data of the two groups were compared, and the related factors of choledocholithiasis recurrent recurrence after minimally invasive surgery were analyzed, Result There was no significant difference in the number of stones, stone size and common bile duct diameter between the two groups （P 〉 0.05）. Single factor analysis showed that the history of biliary surgery （OR = 5.011, P = 1.612）, parapapillary diverticulum （OR = 4.142, P = 1.421）, common bile duct angle （OR = 14.315, P= 2.661）, history of cholecystectomy （OR = 1.736, P = 3.143） were the related factors of recurrent choledocholithiasis after minimally invasive surgery. The results of multivariate analysis showed that a parapapillary diverticulum （β = 1.243, Wald χ2= 6.43, P =0.011）, bile duct angle 〈 45° （13 = 2.548, Wald χ2= 8.56, P = 0.003）, biliary surgery （fl = 1.788, Wald χ2=11.779, P= 0.001） were the risk factors of recurrence of recurrent choledocholithiasis after minimally invasive surgery. Conclusion History of biliary surgery, parapapillary diverticulum and angle of choledocholithiasis are the independent risk factors for influence of recurrence of common bile duct stones phenomenon, and clinicaltreatment of patients should have a full range of treatment and diagnosis to reduce the incidence of recurrence after minimally invasive surgery.