LC联合LCBDE+T管引流术后胆总管结石复发的相关危险因素分析

Analysis of Risk Factors for Recurrence of Common Bile Duct Stones After LC Combined with LCBDE+T Tube Drainage

目的探讨腹腔镜下胆囊切除术(LC)联合腹腔镜下胆总管探查取石术(LCBDE)+T管引流术后胆总管结石的复发率及其复发危险因素。方法回顾性分析2016年4月-2020年1月在我院行LC联合LCBDE+T管引流术的201例患者的临床资料及随访信息。根据患者在随访期间出现结石复发的情况,将患者分为复发组(23例)及未复发组(178例),比较两组的年龄、性别、BMI、高血压病史、糖尿病病史、术前炎症情况、胆总管直径、胆总管结石数目、十二指肠憩室、手术时间等,采用Logistic回归分析筛选出影响结石复发的相关因素。结果201例患者中有23例出现术后结石复发,复发率为11.44%。单因素分析显示:年龄、胆总管直径、胆总管结石数量、十二指肠憩室与结石术后复发有关(P<0.05);性别、BMI、高血压病史、糖尿病病史、术前炎症情况、手术时间与结石复发无关(P>0.05);多因素分析显示:胆总管直径、十二指肠憩室是术后结石复发的独立危险因素(P<0.05)。结论LC联合LCBDE+T管引流术后胆总管结石复发受多个因素影响,应密切注意患有相关影响因素的患者,加强术后随访,尽早干预,以降低胆总管结石的复发率。

Objective To investigate the recurrence rate and risk factors of common bile duct stones after laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE)+T-tube drainage.Methods The clinical data and follow-up information of 201 patients with LC combined with LCBDE+T tube drainage in our hospital from April 2016 to January 2020 were retrospectively analyzed.According to the recurrence of stones during the follow-up period,the patients were divided into the recurrence group(23 cases)and the non-recurrence group(178 cases).The age,gender,BMI,history of hypertension,history of diabetes,preoperative inflammation,diameter of common bile duct,number of common bile duct stones,duodenal diverticulum,and operation time were compared between the two groups.The related factors affecting the recurrence of stones were screened by Logistic regression analysis.Results Totally 23 of 201 patients had postoperative stone recurrence,and the recurrence rate was 11.44%.Univariate analysis showed that age,diameter of common bile duct,number of common bile duct stones and duodenal diverticulum were associated with postoperative recurrence of stones(P<0.05);gender,BMI,history of hypertension,history of diabetes,preoperative inflammation and operation time were not related to stone recurrence(P>0.05).Multivariate analysis showed that common bile duct diameter and duodenal diverticulum were independent risk factors for postoperative stone recurrence(P<0.05).Conclusion The recurrence of choledocholithiasis after LC combined with LCBDE+T tube drainage is affected by multiple factors.Patients with related influencing factors should be paid close attention to.Postoperative follow-up should be strengthened and early intervention should be carried out to reduce the recurrence probability of choledocholithiasis.