腹腔镜胆囊切除术后原发性胆总管结石形成的相关影响因素分析

Analysis of Related Factors in the Formation of Primary Common Bile Duct Stones after Laparoscopic Cholecystectomy (LC)

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy, LC)术后原发性胆总管结石形成的相关影响因素。方法选取2007年1月至2016年12月行LC患者1104例作为研究对象,回顾分析其临床资料及随访资料,对影响LC后原发性胆总管结石形成的相关因素行单因素与多因素分析。结果 1104例行LC患者中形成原发性胆总管结石159例,无结石945例,LC术后发生原发性胆总管结石的概率为14.40%。单因素分析结果显示,LC术后原发性胆总管结石的发生与三酰甘油(TG)、总胆红素(TBil)、直接胆红素(DBil)、糖尿病、脓性胆汁、坏疽性胆囊等因素有关(P<0.05);Logistic多因素回归分析结果显示,TG(OR=0.753,P<0.01)、TBil(OR=0.923,P<0.01)、DBil(OR=0.883,P=0.014)、糖尿病(OR=0.554,P=0.005)、脓性胆汁(OR=0.433,P<0.01)、坏疽性胆囊(OR=0.541,P=0.022)是发生原发性胆总管结石的危险因素。结论 LC术后原发性胆总管结石的发生受多种因素影响,应根据具体情况采取相应措施降低发生率。

Objective To investigate the related factors affecting the formation of primary common bile duct stones after laparoscopic cholecystectomy(LC).Methods A total of 1104 patients with LC were enrolled from January 2007 to December 2016.The clinical data and follow-up data were retrospectively analyzed.The factors related to the formation of primary common bile duct stones after LC were analyzed by single factor and multivariate analysis.Results Of the 1104 patients who underwent LC,159 patients had primary choledocholithiasis,945 had no stone group,and the primary choledocholithiasis rate was 14.40%after LC.Univariate analysis showed that,after LC,the occurrence of primary common bile duct stones was related to triacylglycerol(TG),total bilirubin(TBil),direct bilirubin(DBil),diabetes,purulent bile,gangrenous gallbladder and other factors(P<0.05).Logistic regression analysis showed that TG(OR=0.753,P<0.01),TBIL(OR=0.923,P<0.01),DBIL(OR=0.883,P=0.014),diabetes(OR=0.554,P=0.005),purulent bile(OR=0.433,P<0.01),gangrenous gallbladder(OR=0.541,P=0.022)are risk factors of primary choledocholithiasis.Conclusion The occurrence of primary common bile duct stones after LC is affected by many factors,and it should take appropriate measures for reducing the incidence depending on the circumstances.