Risk Factors Of Postoperative Recurrence Of Gallstones In Patients With Laparoscopic Choledochoscopy-assisted Removal Of Cholecyscithiasis (LRCL):a Meta-analysis

Objective:To evaluate the risk factors for the recurrence of gallstones after laparoscopic choledochoscopy-assisted removal of cholecyscithiasis(LRCL)through a meta-analysis method.Methods: We searched retrospective study of recurrent LRCL patients published in Pub Med,Cochrane Library,EMbase,China Biology Medicine(CBM),China National Knowledge Infrastructure(CNKI),Wiper Database and Wanfang Database,The documents obtained are screened according to the inclusion criteria and exclusion criteria.Then the quality evaluation(NOS)and data extraction were conducted?Finally we used Rev Man 5.0 software to do a meta-analysis.Results:A total of 12 retrospective case control studies with 7214 cases were enrolled.The results of meta-analysis revealed that the risk factors of recurrence of gallstones after laparoscopic choledochoscopy-assisted removal of cholecyscithiasis(LRCL)included Preoperative multiple gallstones(OR=1.11,95%CI : 0.31 ~ 1.92,p < 0.01),Family history of cholelithiasis(OR=1.37,95%CI=0.76~1.98,p<0.01),Obesity(OR=1.04,95%CI:0.61~1.48,p<0.0001),Hyperlipemia(OR=1.12,95%CI:0.65~1.58,p<0.001),Greasy diet(OR=1.41,95%CI:0.45~2.37,p<0.01),Gallbladder wall thickness(OR=1.46,95%CI:-0.00~2.92,p=0.051),Ursodeoxycholic acid(OR=-0.85,95%CI:-1.46~-0.24,p<0.01),age(OR=0.13,95%CI:-0.59~0.86,p=0.718)?sex(OR=0.13,95%CI:-0.03~0.28,p=0.103)?diabetes mellitus(OR=0.55,95%CI:-0.97~2.07,p=0.478)?movement(OR=-0.62,95%CI:-1.30~0.06,p=0.076)?Gallbladder function(OR=2.87,95%CI:1.78~3.95,p<0.0001)History of acute cholecystitis(OR=1.41,95%CI:0.86~1.96,p<0.0001)?hypertension(OR=0.94,95%CI:-0.56~2.43,p=0.2182)?Minority(OR=0.65,95%CI:0.47~0.84,p<0.0001).Conclusions: Multiple gallstones,family history of cholelithiasis,obesity,hyperlipidemia and greasy diet are risk factors for the recurrence of stones after laparoscopic choledochoscopic cholecystolithotomy.The history of acute attack of cholecystitis Gallbladder dysfunction are possible risk factors for the recurrence of calculi after operation.The thickness of gallbladder wall,hypertension,diabetes,exercise habit,age,sex had no significant relationship with the recurrence of stone after cholecystolithiasis.Postoperative oral administration of ursodeoxycholic acid could reduce the recurrence of stone.t.Postoperative gallstone recurrence in patients undergoing laparoscopic choledochoscopy-assisted removal of cholecyscithiasis(LRCL)is affected by the above factors,so the targeted measures should be adopted to reduce the recurrence rate.