Analysis Of Risk Factors For Recurrence Of Hepatolithiasis After Operation

Objective:Hepatolithiasis is a common disease in China.Currently,surgical treatment is the main treatment,but postoperative recurrence of stones is easy to occur.How to reduce the recurrence rate of stones has been the difficulty and focus of the treatment of this disease.Through a retrospective analysis of clinical cases,this study compared the recurrence rate of intrahepatic bile duct stones after different surgical methods,and explored the risk factors of postoperative recurrence of intrahepatic bile duct stones,so as to provide a reference for the prevention of postoperative recurrence of intrahepatic bile duct stones.Methods:(1)A retrospective analysis was conducted on the case data of 223 patients with intrahepatic bile duct stones who received surgical treatment in the department of hepatobiliary surgery of the first affiliated hospital of jishou university from January 2013 to January 2018.According to whether postoperative calculi recurrence was divided into relapse group and recurrence group,observe the following factors and calculi recurrence relations:gender,age,smoking history,wine history,history of hypertension,coronary heart disease history,diabetes history,history of biliary tract surgery,jaundice,stone of bile duct diameter,size,distribution,combination of extrahepatic bile duct stones,merging,suppurative cholangitis,intrahepatic bile duct stenosis,Oddi sphincter dysfunction,operation method,stone residues,etc.(2)Outpatient reexamination and telephone follow-up were conducted.The main follow-up included:postoperative life status,postoperative reexamination,time from surgery to the first recurrence,site of recurrence,and treatment after recurrence.Regular follow-up began 6 months after the operation,and was conducted once every 3months or half a year.The follow-up deadline was September 2018.(3)SPSS22.0 statistical software was used to analyze the data,and the counting data were expressed as rate or constituent ratio.Univariate analysis was performed by?~2test or Fisher's exact test.Unconditioned Logistic regression analysis was performed on variables with statistical significance after univariate analysis.The test level?=0.05,P<0.05 was considered statistically significant.Results:(1)In this study,a total of 223 patients with intrahepatic bile duct stones who underwent surgical treatment were followed up,among whom 213 patients were effectively followed up,with an effective follow-up rate of 95.5%.The median follow-up was 28 months(9-63months).Of the 213 patients who were successfully followed up,37 had recurrent stones,with a recurrence rate of 17.4%.The shortest recurrence time was 8 months after surgery,and the longest recurrence time was 54months after surgery.The cumulative incidence of stone recurrence was3.3%in the first year,6.6%in the second year,10.8%in the third year,13.2%in the fourth year and 17.4%in the fifth year.(2)According to the different conditions of the patients,213 patients with intrahepatic bile duct stones were selected for different surgical methods.There were 134 cases of hepatectomy,accounting for 62.9%of the total cases,and the recurrence rate of postoperative calculi was 14.2%.Fifty-four cases(25.4%)were treated with high bile duct lithotomy+T tube drainage,and the stone recurrence rate was 22.2%.There were 25cases of choledochojejunal roux-en-y anastomosis,accounting for 11.7%,and the recurrence rate of stones was 24.0%.(3)According to the analysis of the influencing factors of postoperative recurrence of intrahepatic bile duct stones,univariate analysis showed that stone distribution,intrahepatic bile duct stenosis,Oddi sphincter dysfunction,and stone residue were risk factors for postoperative recurrence of intrahepatic bile duct stones(P<0.05).The single factor analysis of observation indexes statistically significant Logistic regression analysis showed that have stone residues(OR=16.830,P=0.001),there are Oddi sphincter dysfunction(OR=6.553,P=0.019),with intrahepatic bile duct stenosis(OR=9.720,P=0.003)are independent risk factors for recurrence of intrahepatic bile duct stones,and stones distribution is not independent risk factors for recurrence of intrahepatic bile duct stones(P>0.05).Conclusion:(1)The application of hepatic lobectomy in the treatment of intrahepatic bile duct stones has a low recurrence rate and should be individualized and rationally applied.(2)Residual stones,sphincter Oddi dysfunction,and intrahepatic bile duct stenosis were independent risk factors for recurrence of intrahepatic bile duct stones after surgery.