腹腔镜胆囊结石并胆总管结石切除术后结石残留的影响因素研究

目的探讨腹腔镜下手术治疗胆囊结石并胆总管结石后结石残留的影响因素。方法选择2011年1月至2013年6月行腹腔镜下手术治疗的80例胆囊结石并胆总管结石患者作为研究对象，收集所有患者的临床资料，根据术后有无结石残留将患者分为成功组和失败组。比较两组的胆总管内径、结石大小以及数量等临床资料。结果本研究80例患者中有15例出现结石残留，其余65例取石成功。多因素Logistic回归分析显示解剖异常（OR=2．62，95％CI=1．66～4．15）、胆总管直径〈1em（OR=1．85，95％CI=1．73—1．98）、泥沙样结石（OR=3．47，95％CI=1．80—6．69）、伴有胆管炎（OR=2．67，95％CI=2．00～3．57）、伴有胆总管扩张（OR=2．55，95％CI=1．09—5．95）-、伴有胆管扩张（OR=1．38．95％CI=1．02～1．88）是结石残留的独立危险因素。结论解剖异常、胆总管直径〈1cm、泥沙样结石、伴有胆管炎、伴有胆总管扩张、伴有胆管扩张是术后结石残留的危险因素，可在治疗过程中采取针对性的预防措施，提高疗效。

Study on the influence factors of residual stones after operation of cholecystolithiasis and choledocholith with laparoscopy.

Objective To study the influence factors of residual stones after operation of cholecystolithiasis and choledocholith with lapa- roscopy. Methods 80 cases of cholecystolithiasis and choledocholith with laparoscopy were selected from our hospital from January 2011 to June 2013. To collect the clinical data of the patients. 80 cases were divided into two groups （ successful group and the failure group） by with or without residual stones. To compare the clinical data of internal diameter of common bile duct and the stone size and so on between the two group. Results There were 15 patients had residual stones, there were 65 patients had no residual stones. Multivariate logistic regression analyses showed that anatomic abnormality （ OR = 2.62, 95% CI = 1.66 - 4.15 ）, bile duct diameter was lower than 1 cm （ OR = 1.85, 95% CI = 1.73 - 1.98 ）, muddy stones （ OR = 3.47, 95 % CI = 1.80 - 6.69）, cholangitis （ OR = 2.67, 95 % CI = 2.00- 3.57 ）, choledochectasia （ OR = 2.55, 95 % CI = 1.09 -5.95 ）, cholangiectasis （ OR = 1.38, 95% CI = 1.02 - 1.88 ） were independent risk of residual stones in patients of cholecystolithiasis and choledocholith with laparoscopy. Conclusion Anatomic abnormality, bile duct diameter was lower than 1 cm, muddy stones, cholangitis, choledoehectasia, eholangieetasis were independent risk of residual stones. We can take some pertinent preventive measures to improve the curative effect.