| Endoscopic cholecystolithotomy is a new technique raised for nearly a decade.Since the first description,widespread concern and heated debate has been arousing in the surgical field.The debate focuses on the recurrence of stones.The recurrence of stones often requires cholecystectomy the second operation which increased social burden and operative risk.It must be made clear that preserving the gallbladder is not just an anatomic preservation,but more importantly,how to prevent the recurrence of the stone.If we blindly select the surgical indications,it is bound for the stone recurrence or the occurrence of other gallbladder diseases.Therefore,it is of great significance to study the risk factors of surgical indication and recurrence of stones.Objective To investigate the risk factors of post-cholecystolithotomy stone recurrence and its influence on the indications of gallbladder preserving surgery.Methods Published studies were searched in the CBM,CNKI,VIP,Wan Fang,Pubmed databases,and other relevant journals were also hand searched to identify all the relevant case.Eligible studies were selected according to the predefined inclusion and exclusion criteria.Then the quality evaluation(NOS)and data extraction were conducted.Meta-analysis publication bias examination were done using software Stata 12.0.The risk factors for recurrence of stones are obtained through this process.The clinical data of 738 patients underwent laparoscopic cholecystolithotomy from Jan 2010 to Oct 2015 were retrospectively analyzed,then To observe the recurrence rate and the recurrence time of stone in the presence of single or multiple risk factors.Result1?A total of 7 studies were included in the meta-analysis,including 1098 patients and 345 recurrent cases.The results of the meta-analysis showed that the recurrence incidence after cholecystolithotomy was 29%.It was found that gallbladder wall thickness >3mm?gallbladder dysfunction?family history?multiple stone?aged?gender and diabetes had the pooled OR(95%CI)values as 8.44(4.32,16.50)?2.58(1.93,3.44)?4.47(3.24,6.15)?4.74(3.11,7.25)?0.95(0.70,1.28)?0.92(0.68,1.24)?1.38(0.95,1.99)? 2 ? Seven hundred and thirty eight patients suffered laparoscopic cholecystolithotomy successfully,and followed up for 1-5 years,an average of 3.4 years,75 cases were recurrence,the recurrence rate was 10.2%.Stone recurrence time presented from 1 month to 60 months,mainly concentrated in two areas,one was in 3 months after operation,the other was in 21-24 months after surgery.3?When the age and multiple stone were coexisting,the recurrence rate was 11.3%;when family history combined with multiple stones,the recurrence rate was 18.9%,;when the family history and age were concurrence,the recurrence rate was 11.3%,when age,family history,multiple stones were existing at the same time,the recurrence rate was 35.8%.Conclusion 1?Gallbladder wall thickness>3mm?gallbladder dysfunction?age?family history and multiple stone are positively related to recurrence after holecystolithotomy.Gender and diabetes are not the risk factor.2?Gallbladder dysfunction and gallbladder wall thickness>3mm which should not be used as cholecystolithotomy indications have great affect on increase the recurrence of stone.3?The optimal indications of cholecystolithotomy was elderly patients who only has one stone and no family history;Cholecystolithotomy indications included: normal gallbladder function,gallbladder wall thickening,the number of stones less than 5,without family history(If have family history,the stone number must be single). |
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