Analysis Of Risk Factors For Recurrence Of Choledocholithiasis After Biliary Tract Surgery And The Preventive Effect Of Lidan Decoction

Objectives: Through the way that follow up the patients who had common bile duct stones removal and cholecystectomy, to explore the risk factors for recurrence of choledocholithiasis after biliary tract surgery and the preventive effect of Lidan decoction.Methods: A retrospective analysis about the clinical data of 283 cases were performed, these cases were performed with common bile duct stones removal operation(including OCBDE、LCBDE and EST) and meanwhile cholecystectomy in the first Affiliated Hospital of Dalian Medical University since January 2004 to January 2014, 201 cases of complete data were obtained through the telephone and follow-up visit. According to the common bile duct stones recurrence standard, these patients were divided into recurrence group and non-recurrence group. We make a univariate analysis of the patient’s gender, age, BMI, smoking history, drinking history, hypertension history, diabetes history, surgery methods, the diameter of common bile duct, the size and number of stones, the juxtapapillary duodenal diverticulum(JPD). And the variable that has statistically significant was involved in the non-conditional logistic regression analysis to determine the risk factors for recurrence of common bile duct stones after biliary tract surgery. The patients were divided into the Lidan decoction group and the non-Lidan decoction group according to the standard that taking Lidan decoction more than half a year specificatly. The preventive effect of Lidan decoction to stone recurrence use chi-square test to analysis.Results: Among the 201 cases with complete follow-up datas, 115 male patients, 86 female patients, 30 patients had recur common bile duct stone after biliary tract surgery, and the recurrence rate was 14.9%(30/201), 20 males and 10 females, aged from 30 to 89 years old, the average age of those recurrent patients was 67 years old. The interval of first time to recur from previous surgery was 0.8 to 8.0 year. 1-year, 3-year, 5-year and 8-year cumulative recurrence rate was respectively about 4.9%(10cases), 10.9%(22cases), 13.9%(28cases) and 14.9%(30cases). 43 patients had taken Lidan decoction more than half a year specificatly, among those cases 2 patients recur common bile duct stone. The univariate analysis between the common bile duct stone recurrence group and the non-recurrence group were performed: the recurrence rate of common bile duct stones between the group with a diameter of common bile duct more than 1.5 cm and the group with a diameter of less than 1.5 cm, have a statistically significant difference(P﹤0.05). The group with juxtapapillary duodenal diverticulum compared with the non-juxtapapillary duodenal diverticulum group, the recurrence rate of common bile duct stones was statistically significant difference(P﹤0.05). The postoperative common bile duct stone recurrence rate of multiple stones group(the number of stones more than 2) compared with the single stone group was significantly different(P﹤0.05). However, those factors such as the age, gender, BMI, alcohol using history, smoking history, diabetes history hypertension history, surgery methods and the size of common bile duct stone have no significant difference(P>0.05). After the Logistic regression multivariate analysis, juxtapapillary duodenal diverticulum(P=0.041,OR=2.382), the diameter of common bile duct more than 1.5cm(P=0.021,OR=2.946), are the more important recurrence risk factors, but multiple stones(the number of stones more than 2)(P=0.051,OR=2.612)is not the independent risk factor. Lidan decoction for the prevention of stone recurrence than the non-Lidan decoction group(P﹤0.05), indicating that Lidan decoction in the prevention of recurrence of stones have a role.Conclusion: Juxtapapillary duodenal diverticulum, a diameter of common bile duct more than 1.5cm, are the independent risk factors of common bile duct stone recurrence in the patients after biliary tract surgery. Lidan decotion may have a certain effect to prevent common bile duct recurrence.