| ObjectiveIntrahepatic bile duct stones are one of the most common benign biliary tract diseases in China,which can cause repeated bile duct inflammation,which in turn leads to hepatic leaf atrophy,biliary cirrhosis,and finally can induce cholangiocarcinoma.Surgery is an effective way to treat intrahepatic bile duct stones.However,how to effectively remove stones and remove diseased tissue,reduce the residual rate of stones and recurrence rate is still a difficult problem for hepatobiliary surgeons.This study was designed to retrospectively analyze the risk factors of calculus residual and calculi recurrence in patients with intrahepatic bile duct stones undergoing surgery.It is expected to provide a theoretical basis for the prevention and treatment of residual stones and stone recurrence in patients with intrahepatic bile duct stones undergoing surgery.MethodsThe clinical medical records of 160 patients with intrahepatic bile duct stones who underwent surgery in our hospital for hepatobiliary surgery from January 2010 to March2018 were retrospectively analyzed.According to the residual stones in the operation,the stones were divided into residual stones and residual stones.The factors affecting the residual stones were analyzed by?~2 test or Student's T test,and the independent risk factors were further analyzed by Logstic multivariate analysis.Kaplan-Meier method and Log-rank test were used to analyze the factors related to postoperative calculi recurrence in patients with residual stones without calculus,and the independent risk factors were further analyzed by Cox proportional hazards regression model.The factors associated with postoperative calculi recurrence were selected by Kaplan-Meier method and Log-rank test univariate analysis in patients with residual calculi without partial calculi,and the independent risk factors were further analyzed by Cox proportional hazard regression model.ResultsThe immediate residual rate of all patients after surgery was 36.88%.The complication of all patients after surgery was 34.38%,the most common incision infection.Perioperative mortality was 1.84%.History of previous biliary tract surgery(P=0.01),combined liver segment or hepatic lobe atrophy(P=0.001),serum alkaline phosphatase value(P=0.012),serum?-glutamyltransferase value(P=0.008),the distribution of stones(P<0.001)and surgical procedure(P<0.001)were the influencing factors of intraoperative residual stones in patients with intrahepatic bile duct stones,and further analysis by Logstic multivariate analysis showed that the distribution of stones(P<0.001)and surgical methods(P<0.001)are independent risk factors for residual stones in hepatolithiasis.The distribution of calculi(P=0.025)and surgical methods(P<0.001)were the influencing factors of calculi recurrence in patients with intrahepatic bile duct stones after operation.Further analysis by COX proportional risk model showed that surgical methods(P<0.001)were independent risk factors for calculi recurrence in patients with hepatolithiasis after operation.In patients who underwent partial hepatectomy,the distribution of stones(P=0.008)and the extent of liver resection(P<0.001)were closely related to postoperative calculi recurrence,and further multivariate analysis was performed by COX proportional hazard model showed that the extent of liver resection(P=0.011)was an independent risk factor for the recurrence of stones after selective partial hepatectomy.ConclusionsThe distribution range of stones and surgical methods are closely related to intraoperative residual stones and postoperative calculi recurrence in patients with intrahepatic bile duct stones.It suggests that selecting a reasonable surgical approach based on the patient's distribution of stones is an effective method to improve the short-term and long-term efficacy of intrahepatic bile duct stones.In patients undergoing partial hepatectomy,the extent of hepatectomy directly affects the residual stones during operation and the recurrence of stones after operation,suggesting that on the basis of removing stones,complete resection of the focus area is the fundamental way to improve the short-term and long-term efficacy of intrahepatic bile duct stones. |
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