Study On The Correlation Between The Recurrence Of Hepatolithiasis And The Species Of Bile Flora

Research background and purpose:Hepatolithiasis is a common surgical disease,and its main treatment method is surgical procedure.However,its high postoperative recurrence rate,re-surgery rate and incidence rates of complications are still thorny problems in clinical treatment,there were regional differences in stone recurrence,with higher recurrence rates in coastal areas and Yangtze River Basin.Early and timely effective intervention to reduce the risk of stone recurrence is of great significance to improve the prognosis of patients.However,the mechanism of postoperative recurrence in patients with hepatolithiasis is still unclear.Some studies have suggested that biliary tract bile flora may be involved,but whether there is a correlation between bile flora and stone recurrence in patients needs further study.Therefore,based on pathogen selective culture,this study analyzes the characteristics of biliary tract bile flora in patients with recurrence after laparoscopic hepatectomy for hepatolithiasis,aiming to explore the correlation between biliary tract bile flora and recurrence of hepatolithiasis in Sichuan and Chongqing area,and provide reference for clinical formulation of prevention and treatment strategies.Materials and Methods:94 patients with hepatobiliary duct calculus who were scheduled to undergo laparoscopic hepatectomy in the First Affiliated Hospital of Chengdu Medical Collegeand,Southwest Hospital of Army Military Medical University were selected between May2018 and December 2022.The patients with first episode hepatolithiasis were in the first episode group,and the patients with recurrent hepatolithiasis were in the re-operation group,47 cases in each group.Patients in the two groups received outpatient or telephone follow-up after surgery,and the recurrence of calculus was observed according to the results of upper abdominal B-ultrasound and abdominal CT,The bile samples extracted from the biliary tract were inoculated into 8 selective plate culture mediums including Bifidobacterium,Lactobacillus,Enterococcus,Escherichia coli,Staphylococcus,Yeast,Bacteroides,Peptostreptococcus for plate bacteria count.The content of mucin in the bile of the enrolled patients was determined by enzyme-linked immunosorbent assay with mucin ELISA kit.Result:1.TFrom May 2018 to December 2022,the follow-up time was 6-48 months,with a median follow-up time of 24 months,there were 9 cases of postoperative recurrence of hepatolithiasis among the enrolled patients,with the stone recurrence rate of 9.57%(9/94),including 4 case[8.51%(4/47)]in the first episode group and 5 cases[10.64%(5/47)]in the reoperation group.2.There were no statistically significant differences in the gender,age,body mass index,drinking history,smoking history,underlying disease history(hypertension and diabetes),stone diameter,stone distribution,WBC,TBIL,DBIL,G-GT,ALP,AST,ALT between the two groups(P>0.05).The proportions of patients with common bile duct diameter≥12 mm,intrahepatic bile duct stenosis and intrahepatic biliary infection in recurrence group were higher than those in control group(P<0.05),and the levels of serum C-reactive protein(CRP),tumor necrosis factor(TNF-α),malondialdehyde(MDA)and bile mucin were higher than those in control group(P<0.05).The level of bile mucin in patients with postoperative recurrence in the reoperation group was higher than that in patients with postoperative recurrence in the first group(P<0.05).3.After selective culture of bile samples,73 strains of 7 kinds of microorganisms were detected in recurrence group.96 strains of 8 kinds of microorganisms were detected in control group.In the reoperation group,a total of 8 strains of 4 kinds of microorganisms were detected in patients with postoperative recurrence.A total of 19 strains of 8 kinds of microorganisms were detected in the first group.4.The detection rates of Escherichia coli in the bile samples of the two groups of patients were both 100%,but the proportion of Escherichia coli in the bile of recurrence group was higher than that in control group(P<0.05).The detection rate of Escherichia coli in bile samples of both groups was 100%,but the proportion of Escherichia coli in bile of patients with recurrence in the reoperation group was higher than that of patients with recurrence in the first group(P<0.05).5.The count of Escherichia coli in recurrence group was(7.21±0.74)×10~9CFU/g,which was higher than(6.35±0.62)×10~9 CFU/g in control group(P<0.05).Biliary Escherichia coli count was(7.58±0.21)×10~9 CFU/g in the reoperation group and(6.79±0.16)×10~9 CFU/g in the first group.The number of patients in the reoperation group was higher than that in the first group(P<0.05).6.Binary Logistic regression analysis results showed that common bile duct diameter≥12 mm,intrahepatic bile duct stenosis,intrahepatic biliary infection and Escherichia coli≥6.84×10~9 CFU/g were independent risk factors for postoperative recurrence in patients with hepatolithiasis.7.Escherichia coli count in the bile of patients with hepatolithiasis was a weak positive correlation with serum CRP,TNF-α,MDA and bile mucin(r=0.459,0.580,0.523,0.571,P<0.05).8.Choledochal diameter,intrahepatic bile duct stenosis,intrahepatic biliary infection and biliary Escherichia coli count were closely related to the recurrence of patients with hepatolithiasis during postoperative follow-up(Log Rankχ~2=12.705、9.884、10.726、4.718,P<0.05).Conclusions:1.Sichuan and Chongqing area patients with hepatolithiasis still have stone recurrence after laparoscopic hepatectomy.Postoperative stone recurrence may be related to bile duct dilatation,Biliary tract infection,intrahepatic bile duct stenosis and Escherichia coli count.In addition,compared with patients with first-episode hepatolithiasis,patients with re-operation hepatolithiasis had more serious inflammation,oxidative stress and bile duct tissue damage.2.The distribution of biliary duct bile flora patients with hepatolithiasis is dominated by Gram-negative bacteria,and the detection rate of Escherichia coli is 100%.The count of Escherichia coli in biliflora of patients with re-operation hepatolithiasis was higher than that of patients with first-episode hepatolithiasis.3.The content of Escherichia coli in the bile is a weak positive correlation with serum CRP,TNF-α,MDA and bile mucin,and Escherichia coli may be involved in postoperative recurrence of patients with hepatolithiasis by stimulating bile duct epithelial cells to secrete a large amount of mucin.