Investigation Of The Incidence Of Primary Common Bile Duct Stones After Cholecystectomy And The Relationship Between Them

Background:With the changes in the dietary structure of Chinese people and the continuous improvement of their living standards,the incidence of benign gallbladder diseases represented by gallstone disease has now exceeded 10%.It is a common and frequently-occurring disease faced by ordinary healthy people and has become one of the important issues facing the current public health.Cholecystectomy is the exact procedure for the treatment of benign gallbladder diseases,however it is generally believed that the risk of primary common bile duct stones increases after cholecystectomy,and its incidence is higher.As a result,many patients refused to undergo cholecystectomy because of such concerns,resulting in a significant number of patients with benign gallbladder disease missed the opportunity of cholecystectomy,resulting in recurrent cholecystitis,biliary colic,secondary common bile duct stones,ana even biliary pancreatitis,in more serious cases,is at risk of gallbladder carcinogenesis.However,after reading the literature carefully,we found that there is no recognized data on the incidence of primary common bile duct stones in the natural population.Moreover,due to the various criteria used in the current clinical studies for primary common bile duct stones after cholecystectomy,different authors refer to different standards,resulting in low comparability and poor persuasiveness between the results.Therefore,whether the primary common bile duct stones after the cholecystectomy is higher than the natural population is not clear.So the definition of primary common bile duct stones after cholecystectomy with strict criteria and on this basis to clarify the causal relationship between cholecystectomy and primary common bile duct stones is an urgent problem to be solved.Objective:Combining with domestic and foreign literature and clinical practice to determine the diagnostic criteria for primary common bile duct stones after cholecystectomy;Investigating the incidence of primary common bile duct stones after cholecystectomy;Exploring whether cholecystectomy increases the risk of primary common bile duct stones and the causal association between the two.Methods:Through the examination of domestic and foreign literature,combined with clinical practical research needs,to determine the diagnostic criteria of primary common bile duct stones after cholecystectomy:The clinical data of patients with benign gallbladder diseases from hepatobiliary surgery from January 1,2012 to December 30,2012 were retrieved from the case document management office of Dalian Friendship hospital affiliated to Dalian Medical University,according to whether the cholecystectomy is divided into the cholecystectomy group and the preserved gallbladder group,using a retrospective cohort study to explore the relationship between cholecystectomy and primary common bile duct stones.For the collected clinical data measurement data expressed as x±s,the data of the groups that conformed to the normal distribution were eompared using the independent sample t test;The count data is expressed by the ratio or composition ratio,and the difference between the groups is compared by using the x2 test.The number of patients with primary common bile duct stones in the patient after cholecystectomy was investigated and explore causal relationship between exposure factors(cholecystectomy)and primary common bile duct stones.Results:A total of 269 patients were followed up after Gallbladder surgery,including 124 males and 145 females,with an average age of 54.85±14.61 years,33 gallbladder stones with common bile duct stones.201 gallbladder stonesr 35 gallbladder polyps.and the incidence of primary primary common bile duct stones after cholecystectomy is 6/191;A total of 68 pairs of cases were collected after matching and balancing confounding factors by Propensity Score Matching(PSM).The incidence of primary common bile duct stones in the cholecystectomy group was 2/68.and the incidence of primary common bile duct stones in the preserved gallbladder group was 3/68,and the incidence of primary common bile duct stones was not statistically different between the cholecystectoimy group and the preserved gallbladder group(P=0.650,>0.05).Conclusion:Cholecystectomy does not increase the risk of primary common bile duct stones,and there is no clear causal relationship between the two.Patients of benign gallbladder disease with surgical indications should be actively surgery to avoid serious complications in the later stages.