腹腔镜胆囊切除联合胆总管切开取石T管引流术治疗胆囊结石合并胆总管结石术后复发率及影响因素

Laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage for treatment of choledocholithiasis combined with choledocholithiasis and its influencing factors

目的探讨腹腔镜胆囊切除联合胆总管切开取石T管引流术治疗胆囊结石合并胆总管结石术后复发情况及影响因素。方法对310例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管引流术治疗,术后随访1 a统计复发率,采用单因素分析及多因素Logistic回归分析探讨术后结石复发影响因素。结果入组患者术后结石复发率为4.8%,单因素分析显示,年龄≥60岁、结石数目≥10个、胆总管直径<15 mm、胆总管扩张、胆囊管扩张、碎石术治疗、合并胆管或胰腺炎症、术后饮食不合理的患者术后复发率更高(P<0.05或0.01);多因素Logistic回归分析显示,结石数目、胆总管直径、胆总管扩张、胆囊管扩张、碎石术、合并胆管或胰腺炎症是术后结石复发的影响因素(P<0.01)。结论腹腔镜胆囊切除联合胆总管切开取石T管引流术治疗胆囊结石合并胆总管结石术后复发率略高,其影响因素众多,临床应根据患者情况予以有针对性的干预措施预防复发。

Objective To explore the postoperative recurrence and influencing factod laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage for the treatment of choledocholithiasis combined with choledocholithiasis.Methods A total of 310 patients of gallstone combined with choledocholithiasis were treated with laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage.All patients were followed up for 1 year and the recurrence rate was calculated after operation.Single factor grading and multivariate logistic regression analysis were used to explore the factors affecting postoperative stone recurrence.Results The recurrence rate of stones in the enrolled patients was 4.8%.Univariate analysis showed that patients with age greater than or equal to 60 years old,number of stones greater than or equal to 10,common bile duct diameter less than 15 mm,common bile duct dilation,cystic duct dilation,lithotripsy treatment,combined bile duct,pancreatic inflammation,unreasonable diet had a higher postoperative recurrence rate(P<0.05 or 0.01).Multivariate logistic regression analysis showed that the number of stones,the diameter of the common bile duct,dilatation of the common bile duct,cystic duct dilation,lithotripsy,combined bile duct or pancreatic inflammation were the influencing factors for the recurrence of stones after surgery(P<0.01).Conclusions Laparoscopic cholecystectomy combined with choledocholithotomy and T-tube drainage for the treatment of gallstone combined with choledocholithiasis has a slightly higher recurrence rate.There are many influencing factors.Clinical interventions should be targeted to prevent recurrence according to the patient's condition.