腹腔镜胆囊切除术联合胆总管切开取石T管引流术的复发多因素分析

Multiple factors analysis of recurrence after laparoscopic cholecystectomy, common bile duct exploration and T duct drainage in the treatment of cholecystolithiasis combined with choledocholithiasis

目的探讨胆囊结石合并胆总管结石患者采用腹腔镜胆囊切除术(LC)联合胆总管切开取石T管引流术(LCHTD)治疗后结石复发的发生率及其影响因素。方法回顾性分析2011年6月至2014年1月采用LC+LCHTD治疗的319例胆囊结石合并胆总管结石患者的临床资料,观察术后2~5年内患者胆囊结石复发情况,并探讨影响结石复发的危险因素。采用SAS 10.0软件进行统计学分析,性别、饮酒率、吸烟率、糖尿病患病率、胆囊管扩张率、高血压患病率、≥15 mm胆总管直径患者所占百分比、多发结石患者所占百分比、≥10 mm结石患者所占百分比、胆总管扩张率采用百分比(%)进行统计描述,组间比较采用χ~2检验;多因素分析方法采用非条件Logistic回归分析法;P值<0.05表示差异具有统计学意义。结果术后1年累积复发14例(4.4%)、3年累积复发30例(9.4%)、5年复发累积47例(14.7%);采用非条件Logistic回归进行分析,结果显示结石数目多发、采用碎石术、胆总管扩张、胆囊管扩张是LC+LCHTD术后胆囊结石复发的独立危险因素(OR=1.721,OR=1.582,OR=1.404,OR=1.381,P<0.05)。结论碎石术、胆总管扩张、胆囊管扩张是LC+LCHTD术后胆囊结石复发的独立危险因素。

Objective To investigate the recurrence after laparoscopic cholecystectomy （LC）, common bile duct exploration and T duct drainage （CBDETD） in the treatment of cholecystolithiasis combined with eholedocholithiasis. Methods From June 2011 to January 2014, 319 patients combined with cholecystolithiasis and choledocholithiasis received LC ＋ CBDETD, and clinical data of whom were analyzed retrospectively. Recurrence of stones were recorded within 2 to 5 years after operation, and the risk factors were analyzed. Statistical analysis were performed by using SAS 10.0 software. Count data were expressed as by percentage （%） and examined by using χ2 test, including the rates of gender, smoking, drinking, diabetes, cystic duct dilation, hypertension, common bile duct diameter ≥ 15mm, multiple stones, stones diameter ≥ 10mm percentage and bile duct dilatation. Multivariate analysis were performed by using non conditional Logistic regression analysis. A P value 〈 0. 05 was considered as statistically significant difference. Results There were cumulative 1 - year recurrence rate of 4.4% （ 14/319 ）, 3 years recurrence rate of 9.4% （30/319） and 5 - year recurrence rate of 14.7% （47/319 ）. By using non conditional logistic regression analysis, results showed that the number of stone multiple, the lithotripsy, dilatation of the common bile duct and gallbladder tube expansion was independent risk factors of recurrence after LC ＋ CBDETD （OR = 1. 721, OR = 1. 582, OR =1. 404, OR = 1. 381, P 〈 0. 05）. Conclusion Lithotripsy, dilatation of common bile duct and dilation of the cystic duct are independent risk factors of recurrence of patients underwent LC ＋ CBDETD.