Risk Factors For Retained Common Bile Duct Stones Of Laparoscopic Cholecystectomy

Objective: Take the LC hospitalized patients as the object of study toanalyze and investigate the related risk factors caused the retained commonbile duct (CBD) stones after LC.Methods: We select827cases of LC patients as the objects of studyhospitalized in the General Surgery Department of Beijing ChuiyangliuHospital from January2002to June2013, and collect the potentially relevantfactors with the retained CBD stones before operation and during operation,including age, gender, BMI, medical history of stones, medical history ofstones≥5years, medical history of diabetes, medical history of jaundicepancreatitis, common bile duct diameter(B Ultrasound)≥8mm, preoperativeMRCP, ALT, AST, TBIL, DBIL, ALP, GGT, acute cholecystitis, emergencysurgery, gallbladder removal order, calot triangle adhesion, sludge calculus,stones neck incarcerated, full-type stones, cystic duct thickening, cystic ductreserved≥1cm, The minimum diameter stones≤5mm, The number ofgallbladder stones≥5, partial cholecystectomy, purulent bile, a total of28potentially relevant factors. There are6-12months’telephone follow-up andrecords by specialized persons. If the patients rehospitalize due to the retainedCBD stones after LC or find the retained CBD stones during hospitalization,then we take the corresponding data of cases under the exclusion criteria as thegroup of retained CBD stones, in total of27cases. Other remaining cases, wetake the data of cases under the exclusion criteria as the group of non-retainedCBD stones, in total of627cases.Univariately analyze the relevant factors between the group of retainedCBD stones and the group of non-retained CBD stones after LC, measurementdata using the independent sample T test, count data using χ2test, or Fisherexact test to conduct univariate statistical analysis, group apply the clinicalfactors with statistical significance in univariate statistical analysis, Logistic regression model to conduct multi-factor correlation analysis. For statisticsand graphics, we use statistical software IBM SPSS21.0for statisticaltreatment, and there is statistical significance to regard P＜0.05as difference.Results:1. In the result of measurement data univariate analysis, TBIL, DBIL,ALP, ALT indexes were statistically significant (P＜0.05).2. In the result of count data univariate analysis, medical history ofjaundice pancreatitis, common bile duct diameter (B Ultrasound)≥8mm, calottriangle adhesion, gallbladder removal order, sludge calculus, The minimumdiameter stones≤5mm, The number of gallbladder stones≥5, cystic ductreserved≥1cm were statistically significant (P＜0.05).3. To do a dichotomy logistic regression analysis to the univariateanalysis results with statistical significance, sorted the results according to theinfluence degree, which were: common bile duct diameter (B Ultrasound)≥8mm, gallbladder removal order (retrograde removal), medical history ofjaundice pancreatitis, cystic duct reserved≥1cm, sludge calculus, in total of5indexes are the independent risk factors caused the retained CBD stones afterLC.4. Through the observation in different years, we found that with theincrease of the year, there was an increasing trend in surgical cases, but therewas no significant decline about the incidence of retained CBD stones afterLC5. The proportion of various treatments: in the27cases of retained CBDstones patients,4cases of Open common bile duct exploration,13cases ofremoving stones by ERCP/EST,10cases of conservative treatment relievingsymptoms, and all of them cured without ant special treatment.Conclusion:1. If there are independent risk factors caused the retained CBD stonesafter LC such as: medical history of jaundice and pancreatitis, common bileduct diameter(B Ultrasound)≥8mm, gallbladder removal order (retrograderemoval),sludge calculus, cystic duct reserved≥1cm, we should pay particular attention to them and take appropriate measures before and during LC to helppreventing the occurrence of postoperative retained CBD stones.2. With an annual increase in the number of LC, there is no significantreduce for the incidence of retained CBD stones after LC, which potentiallyreminder that there is no relationship between the incidence of retained CBDstones after LC and doctors’experiences.3. Within the patient occurred retained CBD stones after LC, according tothe condition we can select the conservative treatment as the optimumchoice.if the conservative treatment is invalid, the way of ERCP/EST can bethe preferred,also we can choose Open common bile duct exploration instead.