胆囊结石合并胆总管多发结石治疗效果及其logistic回归分析

Treatment Effect and Logistic Regression Analysis of Gallbladder Stones Combined with Multiple Stones in the Common Bile Duct

目的:基于logistic回归分析胆囊结石合并胆总管多发结石治疗效果及其影响因素,为临床防治提供参考依据。方法:选取2020年1月—2022年1月南阳市第一人民医院收治的150例胆囊结石合并胆总管多发结石患者作为研究对象,均行腹腔镜胆囊切除(LC)联合腹腔镜胆总管探查(LCBDE)术,随访1年,根据术后是否复发进行分组,对两组相关因素进行单因素和多因素非条件的logistic回归分析。结果:随访显示,150例胆囊结石合并胆总管多发结石患者中,术后有18例结石残留,残留率为12.00%(18/150);术后37例复发,纳入观察组,复发率为24.67%(37/150),未复发113例,纳入对照组。观察组胆固醇水平、胆总管直径、乳头旁憩室、胰管反复显影、胆管角成角、合并炎症患者比例高于对照组,差异有统计学意义(χ^(2)=4.745、7.037、15.270、10.784、20.156、23.180,P<0.05)。胆固醇水平(>5.72 mmol/L)、胆总管直径(≥1.5 cm)、乳头旁憩室、胰管反复显影、合并炎症是胆囊结石合并胆总管多发结石术后复发危险因素,胆总管成角(>120°)是保护因素。结论:胆固醇水平、胆总管直径、乳头旁憩室、胰管反复显影、胆管角、合并炎症是胆囊结石合并胆总管多发结石术后复发的影响因素,临床应重视此类患者的术前评估及术后操作,以降低术后结石复发风险。

Objective:Based on logistic regression analysis,the treatment effect and influencing factors of gallbladder stones with multiple common bile duct stones were analyzed,so as to provide reference for clinical prevention and treatment.Methods:A total of 150 patients with gallbladder stones and multiple bile duct stones admitted to the hospital from January 2020 to January 2022 were selected.All patients underwent laparoscopic cholecystectomy combined with laparoscopic exploration of the common bile duct.They were followed up for 1 year and grouped according to postoperative recurrence.Univariate and multivariate unconditional logistic regression analysis was performed on the two groups of related factors.Results:The follow-up results showed that among 150 cases of gallbladder stones combined with multiple stones in the common bile duct,18 cases had residual stones after surgery,with the residual rate of 12.00%(18/150);37 cases recurred,with the recurrence rate of 24.67%(37/150);113 cares were with no reccurence.The observation group had a higher proportion of patients with cholesterol levels,common bile duct diameter,papillary diverticulum,pancreatic duct recurrence,bile duct angle,and concurrent inflammation compared to the control group,with statistically significant difference(P<0.05).Cholesterol levels(>5.72 mmol/L),diameter of the common bile duct(≥1.5 cm),papillary diverticulum,repeated visualization of the pancreatic duct,and concomitant inflammation were risk factors for postoperative recurrence of gallbladder stones with multiple common bile duct stones,while angle of the common bile duct(>120°)was the protective factor.Conclusion:Cholesterol levels,diameter of the common bile duct,papillary diverticulum,repeated imaging of the pancreatic duct,bile duct angle,and concurrent inflammation are the influencing factors for postoperative recurrence of gallbladder stones with multiple common bile duct stones.Clinical attention should be paid to the preoperative evaluation and postoperative procedures of such patients to reduce the risk of postoperative stone recurrence.