| Object:To analyze the clinical efficacy of choledochoscopic gallbladder-preserving cholecystolithotomy(CGPC)and the relationship between the recurrence of calculous cholecystitis(CCS)and the relative factors.Methods:(1)Clinical efficacy of CGPC:Clinical data of patients with CCS who underwent laparoscopic cholecystectomy(LC)or CGPC at the Xinjiang Military Region General Hospital from March 2009 to March 2012 was collected.The retrospective analysis method was used to analyze the LC group and the CGPC group.The observation index was the operation time,intraoperative blood loss,postoperative exhaust time,postoperative outpatient activity time,hospitalization time,and postoperative complication rate of patients with CCS who underwent LC or CGPC.(2)Related factors of recurrence of gallstones after CGPC:The clinical data of patients successfully undergoing CGPC in the Xinjiang Military Region General Hospital from March 2009 to September 2016was collected.A retrospective cohort study was performed to analyze the recurrent and non-recurrent group of CCS after CGPC.The follow-up time ended in December 2016.The observation indicators were the thickness of the gallbladder wall before CGPC,whether the gallbladder wall was smooth,whether there was cholesterol deposition in the gallbladder wall,whether there were stones in the gallbladder wall,whether there was gallbladder separation,the number of CCS,whether there was gallbladder neck stone incarceration,whether it is a gallbladder sediment-like stone,whether there has been an episode of biliary colic.Results:(1)Clinical efficacy of CGPC:Compared with the LC group,the operative time,intraoperative blood loss,postoperative exhaust time,postoperative time to get out of bed,length of hospital stay,and postoperative complication rate in the CGPC group were statistically significant(t/?~2:11.543,6.846,8.039,5.984,2.464,14.843;P<0.05).After comparison,the above indicators of the CGPC group were lower than those of the LC group.(2)Related factors of recurrence of gallstones after CGPC:The follow-up time was 3 to 60 months,with a median of 41 months.A total of 59(7.04%)cases of CCS recurred after CGPC,and 135(13.87%)were lost to follow-up.Correlation analysis of CCS recurrence during follow-up date:(1)The recurrence rate of gallbladder wall thickness 4~5mm was 8.65%(43/497).The recurrence rate of the gallbladder wall was8.07%(54/669).The recurrence rate of cholesterol deposition in the gallbladder wall was 11.11%(6/54).The recurrence rate of gallstones between the gallbladder walls was 11.39%(9/79).The recurrence rate in the gallbladder compartment was 7.02%(4/57).The recurrence rate of gallstones with multiple stones was8.39%(47/560).The recurrence rate of gallstone incision in the gallbladder neck was 13.89%(5/36).The recurrence rate of gallstone-like stones was 22.22%(4/18).The recurrence rate of biliary colic attacks was17.50%(7/40).(2)Univariate analysis showed relevant factors:preoperative gallbladder wall thickness,whether it was smooth gallbladder wall,number of gallstones,whether it was gallbladder sediment,whether there was biliary colic(z/?~2:-2.216,5.389,4.717,4.186,7.021;P<0.05).(3)COX regression model analysis found independent factors:the number of preoperative gallstones(b=-0.737,P=0.027,95%CI=0.249?0.919),preoperative history of biliary colic(b=0.938,P=0.031,95%CI=1.089?5.998).Conclusion:(1)Compared with LC,CGPC also has a good clinical effect.CGPC meets the patient's expectation of reducing surgical complications and improving postoperative quality of life,and the total postoperative recurrence rate is not high,which has a good application prospect.(2)The number of gallstones and the history of preoperative biliary colic are independent factors of recurrence of CCS after CGPC.Postoperative prevention of recurrence of CCS should be strengthened when CCS combines with gallbladder wall cholesterol deposition,gallbladder wall stones,gallbladder neck stone incarceration,or gallbladder sediment-like stones. |
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