腹腔镜胆囊切除联合胆总管切开取石T管引流术后结石复发情况及术后结石复发的相关危险因素分析

目的探究腹腔镜胆囊切除(LC)联合胆总管切开取石T管引流术(LCHTD)后结石复发及复发相关危险因素。 方法回顾性分析2014年1月至2016年6月行LC联合LCHTD治疗的89例胆结石合并胆总管结石患者的临床资料，采用SPSS21.0统计软件分析，术后结石复发率、1～3年累计复发率和单因素分析采用χ²检验，多因素分析采用logistic回归分析，计算OR和95%可信区间，P<0.05为差异有统计学意义。 结果术后18例患者出现结石复发情况，复发率为20.22%，累计复发率分别为：1年2.25%(2/89)，2年5.62%(5/89)，3年12.36%(11/89)。单因素分析显示：年龄、胆总管直径、结石数量、碎石术、胆总管扩张、胆囊管扩张、合并胆管或胰腺炎症与联合术后结石复发有关(P<0.05)；多因素分析显示：胆总管直径≥1.5 cm、胆总管扩张、胆囊管扩张、合并胆管或胰腺炎症是联合术后结石复发的独立危险因素。 结论胆囊结石合并胆总管结石行LC联合LCHTD治疗后结石复发的影响因素较多，且部分因素会合并出现，有必要采取有针对性的措施以期降低术后结石复发率。

Clinical analysis of recurrence of calculi and its related risk factors after laparoscopic cholecystectomy combined with laparoscopic choledocholithotomy T-tube drainage

ObjectiveTo analyze the recurrence of calculi and its related risk factors after laparoscopic cholecystectomy (LC) combined with laparoscopic choledocholithotomy T-tube drainage (LCHTD). MethodFrom January 2014 to June 2016, clinical data of 89 cases of cholelithiasis combined with choledocholithiasis treated by LC combined with LCHTD, were analyzed retrospectively by using SPSS21.0 statistical software package. The recurrence rate, cumulative recurrence rate in 1-3 years and univariate analysis were performed by using χ² test, while multivariate analysis was performed by using logistic regression analysis, and OR and 95% confidence interval were calculated. A P value of <0.05 was considered as statistically significant. ResultsThe recurrence of calculi occured in 18 patients(20.22%) after LC combined with LCHTD, The cumulative recurrence rate was 2.25%(2/89) in one year, 5.62%(5/89) in two years and 12.36%(11/89) in three years. Univariate analysis showed that age, diameter of common bile duct, number of stones, lithotripsy, choledochal dilatation, cystic duct dilatation, combined with biliary or pancreatic inflammation were associated with recurrence of stones after combined surgery (P<0.05). Multivariate analysis showed that diameter of common bile duct(>1.5 cm), choledochal dilatation, cholecystic duct dilatation, combined with biliary or pancreatitis Symptoms were the independent risk factors for stone recurrence after combined surgery. ConclusionThere are many factors influencing the recurrence of calculi after LC combined with LCHTD, even some of them would occur together. It is necessary to take pertinent measures to reduce the recurrence rate of calculi after LC combined with LCHTD.