| BackgroundCholedocholithiasis is a common disease in hepatobiliary surgery,and ERCP is the preferred treatment at present,but its high recurrence rate has troubled many clinicians.According to literature reports,the recurrence rate of choledocholithiasis after ERCP lithotomy is up to 4%-24%.It is of great significance to find out the risk factors of stone recurrence and early intervention for high risk patients to reduce the recurrence rate of stone.The common bile duct stone formation and recurrence of mechanism is still unclear,factors related to anatomy,surgery,basic diseases such as multiple factors,despite related research at home and abroad,but there is no unified conclusion,and when multiple risk factors exist at the same time,no effective screening high-risk patients can guide clinicians tools,needs further exploration.Objective:1.To explore the related risk factors for stone recurrence in patients with common bile duct stones after ERCP lithotomy.2.The risk scoring system for choledocholithiasis occurrence after ERCP lithotomy has been preliminarily established to provide clinical basis for the clinical judgment of patients at high risk of recurrence of calculi,so as to reduce the recurrence rate of calculi through early intervention.Method:Clinical data of patients with common bile duct stones who underwent ERCP surgery in a hospital from January 2017 to December 2019 were collected.All patients were followed up to December 31,2020,and a database was established.Desptive analysis,univariate analysis and multiple regression analysis were conducted with SPSS26.0 software for various factors that may be related to the recurrence of calculi,and P<0.05 indicated statistically significant difference.The relevant risk factors were screened out and a scoring model was established,and the effectiveness of the scoring model was tested.Result:A total of 382 patients were successfully enrolled.Among the 382 patients in the whole group,53 patients had recurrent choledocholithiasis,with an incidence of13.9%.Single factor analysis showed that age 65 or higher,BMI≥25 kg/m~2or merged by the duodenal papilla diverticulum,common bile duct diameter 15 mm or higher,combination of biliary stricture,bravery manager stone diameter 15 mm or higher,bile duct Angle of<130~o,bravery manager number 2 or more,ERCP lithotomy slitting line number 2 or more times and always bravery manager stone extraction for the stones and the ERCP is closely related to the recurrence after common bile duct calculi;Multi-factor analysis showed that age≥65 years,BMI≥25kg/m~2,number of common bile duct stones≥2,combined with duodenal diverticulum,biliary duct Angle<130~o,combined with biliary stricture,and previous choledocholithotomy were independent risk factors for stone recurrence after ERCP.According to the independent risk factors in the multiple regression,a scoring system was established,and the Youden index was calculated,which was divided into two groups with a threshold value of 3.5:the low-risk group(0-3 points,0-3 risk factors),and the high-risk group(≥4 points,≥4risk factors).The recurrence rate of stone in low risk group and high risk group was26.4%and 73.6%,respectively,the difference was statistically significant(P<0.001).Hosmer-Lemeshow goodness of fit test of Logistic regression model for risk factors of stone recurrence showed good goodness of fit of Logistic regression model(P=0.780).The AUC of the prediction model of the scoring system was 0.828(95%CI:0.765-0.891),indicating good differentiation of the scoring system.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the scoring system were 73.58%,80.85%,79.84%,73.58%and 95%respectively,indicating that the prediction effect was good.Conclusions1.patients were 65 years old,BMI≥25 kg/m~2or ERCP lithotomy by the number 2 or more times,merge duodenal papilla diverticulum,common bile duct diameter 15 mm or higher,combination of biliary stricture,bile duct Angle of<130~o,bravery manager number 2 or more,the diameter of common bile duct calculi,15 mm or more,the history of common bile duct incision and ERCP lithotomy with number 2 or more times after ERCP lithotomy is closely related to the common bile duct calculi recurrence;Patients with age≥65 years old,BMI≥25kg/m~2,complicated duodenal parapillary diverticulum,bile duct Angle<130~o,complicated biliary stricture,≥2choledocholithiasis,and previous history of choledocholithiasis were independent risk factors for postoperative stone recurrence.2.In this study,the risk scoring system for stone recurrence after ERCP lithotomy proposed according to the risk factors of recurrence has good differentiation and predictability,which can help clinicians to predict the risk of stone recurrence simply and effectively. |
