Analysis Of Risk Factors For Recurrence Of Choledocholithiasis After Minimally Invasive Treatment

Objectives Choledocholithiasis,as a kind of cholelithiasis,is a common disease of digestive system.At present,minimally invasive stone extraction is the main clinical treatment,however,the problem of how to reduce stone recurrence after stone removal has not been well solved.This study retrospectively analyzed the risk factors of stone recurrence after minimally invasive treatment choledocholithotomy in our hospital,in order to provide theoretical basis for the prevention of choledocholithiasis recurrence.Methods From October 2016 to February 2019,a total of 151 patients with minimally invasive treatment choledocholithiasis were treated in the Department of Hepatobiliary Pancreatic and splenic surgery of Hebei General Hospital,the patients were routinely diagnosed by imaging examination before surgery.The information of recurrence was obtained by telephone follow-up,and 133 meaningful cases were included after screening,according to whether there was stone recurrence or not,the patients were divided into recurrent group and non-recurrent group.Collect the patients’ relevant data of sex,age,body mass index,history of hepatitis B virus infection,history of diabetes,jaundice,parapapillary duodenal diverticulum,preoperative cholangitis or pancreatitis infection,history of biliary surgery or cholecystectomy,common bile duct diameter,number of common bile duct stones,surgical treatment for analysis.First useχ2test for single factor analysis,get statistically significant single factor,and then do Logistic regression for multi-factor analysis,and finally get independent risk factors.Results 133 patients pay a return visit among 151 patients,the lost rate was 11.92%,19 patients with postoperative choledocholithiasis,the recurrence rate was 14.28%.On the test of single factor analysis in patients with age,body mass index,jaundice,duodenal periampullary diverticulum,preoperative cholangitis or pancreatitis infection,previous history of bile duct operation or cholecystectomy,common bile duct diameter ≥15mm,number of common bile duct stones≥2,it is proved that there were statistical significance(P<0.05),but gender,diabetes,history of hepatitis B virus infection and mode of operation,it is proved that there were not statistical significance(P>0.05).Logistic multivariate analysis showed that history of biliary surgery or cholecystectomy[OR=5.687(95%CI : 1.406~23.010),P=0.015],parapapillary duodenal diverticulum[OR=5.787(95%CI:1.329~25.192),P=0.019]and diameter of common bile duct≥15mm[OR=8.465(95%CI:1.813~39.518),P=0.007]were independent risk factors for recurrence of choledocholithiasis after minimally invasive treatment choledocholithotomy.Conclusions 1 The independent risk factors for recurrence of choledocholithiasis after minimally invasive treatment choledocholithotomy include: History of biliary surgery or cholecystectomy;juxtapapillary duodenal diverticulum;The diameter of the common bile duct≥15mm.2 For patients with high-risk recurrence factors,clinical follow-up and combined methods such as medication and dietary guidance should be used to prevent recalculation of stones.Figure[0];Table[4];Reference [153].