| [Objective]To study the related risk factor of recurrence after the treatment of choledochojejunostomy in hepatolithiasis.[Methods]1.Research object:Retrospective analysis was performed on all clinical data of patients with hepatolithiasis who underwent biliary jejunostomy in the second affiliated hospital of kunming medical university from June 2014 to June 2019.2.Research content(1)The effects of general data and surgical data on the recurrence of calculi were analyzed.(2)General information includes:(1)age;(2)gender:divided into male and female groups;(3)BMI;(4)history of alcoholism:divided into two groups:yes and no;(5)smoking history:divided into two groups:yes and no;(6)history of hypertension:divided into two groups with or without hypertension;(7)diabetes history:divided into two groups:with and without;(8)hepatitis history:divided into two groups:with and without;(9)history of cirrhosis:divided into two groups:with and without;(10)stone size:the maximum length and diameter measured by imaging was used as the observed value,which was divided into two groups:?10 mm and?10 mm.(11)diameter of common bile duct:the maximum diameter of common bile duct was measured by preoperative ultrasound,MRI,MRCP and other imaging methods,and was divided into two groups:?20mm and?20mm.(12)stone location:divided into single and multiple groups;(13)preoperative biliary tract inflammation:the patients were divided into two groups:merger and no merger.(3)The surgical data included:(1)suture methods:divided into two groups:stapler and manual suture;(2)suture method:divided into two groups:continuous and discontinuous;(3)seam thickness:divided into two groups,3-0 to 4-0,5-0 to 6-0;(4):The length of the Y Loop:divided into two groups:40-60cm and 60-70cm;(5)T-tube:divided into two groups:yes and no;(6)biliary drainage method:divided into two groups:yes and no;(7)hepatectomy:divided into two groups:combined group and non-combined group;(8)postoperative bile leakage:divided into two groups:combined group and non-combined group.3.Research study:According to the criteria for recurrence of bile duct stones,the included patients were divided into the recurrence group and the non-recurrence group.SPSS 21.0 statistical software was used for statistical treatment,and then the related risk factors for recurrence of hepatobiliary stones were determined through single-factor and multi-factor analysis.The measurement data were expressed as((?)ąs)and t test was used.?2 test was used for counting data.Logistic regression analysis was performed for the variables with statistical significance after univariate analysis.P?0.05 indicates that the difference is statistically significant.[Results]1.A total of 77 patients with hepatolithiasis underwent choledochojejunostomy were included in this study,all of whom were followed up successfully,including 21 in the recurrence group and 56 in the non-recurrence group.2.Univariate analysis(1)general clinical data:Age(t=1.499,P=0.138),gender(chi-square=0.217,P =0.642),body mass index(t=0.568,P=0.537),smoking(chi-square=0.175,P=0.676),alcohol(chi-square=0.506,P=0.477),whether to have high blood pressure(chi-square=0.655,P=0.418),whether to have diabetes(chi-square=0.380,P=0.538),is there a hepatitis(chi-square=0.982,P=0.322),and whether there is cirrhosis of the liver(chi-square=0.058,P=0.810)in this study,there was no statistically significant difference in the effect on the recurrence of hepatolithiasis after choledochojejunostomy(P?0.05).And stone size?10 mm(chi-square=8.989,P=0.003),the diameter of common bile duct,<20 mm(chi-square=5.456,P=0.019),stones location more than(chi-square=4.353,P=0.037),with biliary tract inflammation(chi-square=5.631,P=0.018)in the study of the effect on bile duct jejunum anastomosis of postoperative recurrence of hepatolith was statistically significant(P?0.05).(2)surgery related:continuous or intermittent mode of suture(chi-square=0.314,P=0.575),3-0?4-0 or 5-0?6-0 degree of suture(chi-square=0.035,P=0.851),40?60 cm or 60?70 cm Y loop length(chi-square=1.695,P=0.193)in the study of the effect on bile duct jejunum anastomosis of postoperative recurrence of hepatolith there was no statistically significant difference(P?0.05).Using stapling anastomosis(chi-square=6.379,P=0.012),without T-tube(chi-square=7.495,P=0.006),no biliary drainage(chi-square=7.228,P=0.007),no liver resection(chi-square=5.631,P=0.018),merging,postoperative bile leakage(chi-square=4.845,P=0.028)in the study of the effect on bile duct jejunum anastomosis of postoperative recurrence of hepatolith was statistically significant(P?0.05).3.multivariate analysi(1)general clinical data:the size of the stone?10mm(OR=2.359,p=0.028),the diameter of the common bile duct?20mm(OR=3.043,p=0.011),the multiple locations of the stone(OR=2.314,p=0.020),and the presence of biliary tract inflammation(OR=1.325,p=0.039)had statistically significant effects on the recurrence of hepatolithiasis after choledojejunostomy in this study(p?0.05).(2)surgery related:line using stapling bile duct jejunum anastomosis(OR=6.731,p=0.023),anastomotic T-tube(OR=4.853,p=0.016),no biliary drainage(OR=7.586,p=0.007)and no corresponding liver resection(OR=8.295,p=0.002)in the study of the effect on bile duct jejunum anastomosis of postoperative recurrence of hepatolith was statistically significant(p?0.05).In this study,the effect of postoperative bile leakage(OR=1.325,p=0.188)on the recurrence of hepatolithiasis after choledochojejunostomy was not statistically significant(p?0.05).[Conclusion]1.Stone size?10 mm,choledochal diameter ?20mm,stone location,biliary inflammation were risk factors for recurrence of hepatolithiasis after biliary jejunectomy.Age,sex,body mass index,smoking,alcoholism,hypertension and cirrhosis are not risk factors for recurrence of hepatolithiasis after choledoj ej unostomy.2.Anastomotic anastomosis,no T-tube,no biliary drainage and no hepatectomy were risk factors for recurrence of hepatolithiasis after biliary jejunectomy.Postoperative bile leakage is not a risk factor for recurrence of hepatolithiasis after choledochojejunostomy. |
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