肝内外胆管结石患者术后结石复发的危险因素分析

Analysis of Risk Factors for Postoperative Stone Recurrence in Patients with Intrahepatic and Extrahepatic Bile Duct Stones

目的:调查肝内外胆管结石患者术后结石复发情况,分析结石复发危险因素。方法:选择2019年3月至2022年1月在桐柏县人民医院诊治的78例肝内外胆管结石患者作为研究对象,所有患者都给予腹腔镜左半肝切除术治疗,记录患者近期预后、随访复发情况,并对患者复发的危险因素进行分析。结果:所有患者术后随访1年,78例患者中复发10例(复发组),复发率为12.82%。单因素分析显示,复发组的Child分级、病程、多发结石、结石最大径与未复发组比较,差异均具有统计学意义(P<0.05)。多因素logistic回归分析结果显示,Child分级B级、病程≥3个月、多发结石、结石最大径≥1.25 cm为导致肝内外胆管结石患者术后结石复发的危险因素(P<0.05)。结论:肝内外胆管结石患者术后结石复发依然比较高,Child分级B级、病程≥3个月、多发结石、结石最大径≥1.25 cm为患者复发的独立危险因素,需重点关注符合其中一项或多项的患者,以保证手术的效果。

Objective To investigate the recurrence of postoperative stone in patients with intrahepatic and intrahepatic bile duct stones and analyze the risk factors of stone recurrence.Methods The study population comprised 78 patients with intrahepatic and extrahepatic bile duct stones who were diagnosed and treated at Tongbai County People’s Hospital from March 2019 to January 2022.All patients underwent laparoscopic left hemihepatectomy.Data on short-term prognosis and recurrence during follow-up were recorded,and the risk factors for recurrence in these patients were analyzed.Results All patients were followed up for 1 year after surgery,and 10 of 78 patients had relapse(relapse group),the recurrence rate was 12.82%.Univariate analysis showed that the Child grade,disease course,multiple stones and maximum stone diameter in the recurrence group were significantly different from those in the non-recurrence group(P<0.05).Multivariate logistic regression analysis showed that Child grade B,disease duration≥3 months,multiple stones and maximum stone diameter≥1.25cm were risk factors for postoperative stone recurrence in patients with intrahepatic and intrahepatic bile duct stones(P<0.05).Conclusion Postoperative stone recurrence is still relatively high in patients with intrahepatic and intrahepatic bile duct stones.Child grade B,disease duration≥3 months,multiple stones,and maximum stone diameter≥1.25cm are independent risk factors for recurrence.Patients who meet one or more of these criteria should be paid attention to to ensure the effect of surgery.