Analysis Of Relevant Factors Affecting The Formation Of Primary Choledocholithiasis After Laparoscopic Cholecystectomy

Objective:To explore the relevant factors affecting the formation of primary choledocholithiasis after laparoscopic cholecystectomy,to provide the basis for clinical prevention of primary choledocholithiasis.Methods:1282 patients undergoing laparoscopic cholecystectomy due to cholecystolithiasis from January 2007 to December 2016 were selected,and 1104 patients of them were included by telephone and follow-up.These patients were divided into Calculus group and Non-calculus group according to the patients followed up for the occurrence of primary choledocholithiasis.The retrospective analysis on clinical data and follow-up data were performed.The history of present illness,past history,auxiliary examination and treatment process at the time of admission of the patients were redorded in detail,and the information on the sex,age,weight,height,hypertension,diabetes and duodenal papillary diverticulum of the patients,preoperative TG ? TC ? HDL ? LDL ? TBIL ? DBIL level,number of calculus(single/multiple),purulent bile,noma cholecystitis and whether the minimum diameter of calculus was less than 5 mm were recorded too.The single factor analysis was performed to the related factors,and then the factors with statistical difference were analyzed by multivariate statistics to determine the risk factors for the formation of primary choledocholithiasis after laparoscopic cholecystectomy.Results:There were 1104 patients obtaining successful follow-up data(13.88%)in 1282 patients,there were 159 patients with primary choledocholithiasis after operation,and 945 patients without primary choledocholithiasis,with the incidence of primary choledocholithiasis of 14.40% after laparoscopic cholecystectomy.Single factor analysis of Calculus group and the Non-calculus group after laparoscopic cholecystectomy showed that the incidence of primary choledocholithiasis was significantly increased in patients with diabetes mellitus,duodenal parapillary diverticulum,purulent bile and gangrenous cholecystitis(P <0.05).The preoperative TC,TBIL and DBIL level of Calculus group was higher than that of Non-calculus group,and there was statistical difference(P <0.05).There was no statistical difference between the two groups in gender,age,hypertension,number of calculus,calculus diameter,BMI,TG,HDL and LDL(P >0.05).The factors with statistical differences were analyzed by Logistic multivariate regression,TC,TBIL,DBIL,diabetes mellitus,purulent bile,noma cholecystitis and duodenal papillary diverticulum were all statistically different(P <0.05),Diabetes mellitus,hypercholesterolemia,parapapillary diverticulum of duodenum,increase of TBIL,increase of DBIL,pyogenic bile and gangrenous cholecystitis are independent risk factors for the formation of primary choledocholithiasis after laparoscopic cholecystectomy(OR > 1).Conclusion:Diabetes mellitus,hypercholesterolemia,TBIL,DBIL,purulent bile,noma cholecystitis and duodenal papillary diverticulum are risk factors for the formation of primary choledocholithiasis after laparoscopic cholecystectomy.