[1]姚 康,童朝刚.LC联合LCBDE+T管引流术后胆总管结石复发的相关危险因素分析[J].医学信息,2022,35(05):98-100,120.[doi:10.3969/j.issn.1006-1959.2022.05.024]
　YAO Kang,TONG Chao-gang.Analysis of Risk Factors for Recurrence of Common Bile Duct Stones After LC Combined with LCBDE+T Tube Drainage[J].Medical Information,2022,35(05):98-100,120.[doi:10.3969/j.issn.1006-1959.2022.05.024]
点击复制

LC联合LCBDE+T管引流术后胆总管结石复发的相关危险因素分析()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
35卷
期数:
2022年05期
页码:
98-100,120
栏目:
论著
出版日期:
2022-03-01

文章信息/Info

Title:
Analysis of Risk Factors for Recurrence of Common Bile Duct Stones After LC Combined with LCBDE+T Tube Drainage
文章编号:
1006-1959（2022）05-0098-04
作者:
姚 康; 童朝刚
（安徽医科大学附属巢湖医院肝胆外科，安徽 巢湖 238000）
Author(s):
YAO Kang; TONG Chao-gang
(Department of Hepatobiliary Surgery,Chaohu Hospital Affiliated to Anhui Medical University,Chaohu 238000,Anhui,China)
关键词:
胆总管结石; 胆囊结石; 复发; 腹腔镜胆囊切除术; 腹腔镜下胆总管探查取石术
Keywords:
Common bile duct stone; Gallstones; Recurrence; Laparoscopic cholecystectomy; Laparoscopic choledocholithotomy
分类号:
R657.4
DOI:
10.3969/j.issn.1006-1959.2022.05.024
文献标志码:
A
摘要:
目的 探讨腹腔镜下胆囊切除术（LC）联合腹腔镜下胆总管探查取石术（LCBDE）+T管引流术后胆总管结石的复发率及其复发危险因素。方法 回顾性分析2016年4月-2020年1月在我院行LC联合LCBDE+T管引流术的201例患者的临床资料及随访信息。根据患者在随访期间出现结石复发的情况，将患者分为复发组（23例）及未复发组（178例），比较两组的年龄、性别、BMI、高血压病史、糖尿病病史、术前炎症情况、胆总管直径、胆总管结石数目、十二指肠憩室、手术时间等，采用Logistic回归分析筛选出影响结石复发的相关因素。结果 201例患者中有23例出现术后结石复发，复发率为11.44%。单因素分析显示：年龄、胆总管直径、胆总管结石数量、十二指肠憩室与结石术后复发有关（P＜0.05）；性别、BMI、高血压病史、糖尿病病史、术前炎症情况、手术时间与结石复发无关（P＞0.05）；多因素分析显示：胆总管直径、十二指肠憩室是术后结石复发的独立危险因素（P＜0.05）。结论 LC联合LCBDE+T管引流术后胆总管结石复发受多个因素影响，应密切注意患有相关影响因素的患者，加强术后随访，尽早干预，以降低胆总管结石的复发率。
Abstract:
Objective To investigate the recurrence rate and risk factors of common bile duct stones after laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE)+T-tube drainage.Methods The clinical data and follow-up information of 201 patients with LC combined with LCBDE+T tube drainage in our hospital from April 2016 to January 2020 were retrospectively analyzed. According to the recurrence of stones during the follow-up period, the patients were divided into the recurrence group (23 cases) and the non-recurrence group (178 cases). The age, gender, BMI, history of hypertension, history of diabetes, preoperative inflammation, diameter of common bile duct, number of common bile duct stones, duodenal diverticulum, and operation time were compared between the two groups. The related factors affecting the recurrence of stones were screened by Logistic regression analysis.Results Totally 23 of 201 patients had postoperative stone recurrence, and the recurrence rate was 11.44%. Univariate analysis showed that age, diameter of common bile duct, number of common bile duct stones and duodenal diverticulum were associated with postoperative recurrence of stones (P<0.05); gender, BMI, history of hypertension, history of diabetes, preoperative inflammation and operation time were not related to stone recurrence (P>0.05). Multivariate analysis showed that common bile duct diameter and duodenal diverticulum were independent risk factors for postoperative stone recurrence (P<0.05).Conclusion The recurrence of choledocholithiasis after LC combined with LCBDE+T tube drainage is affected by multiple factors. Patients with related influencing factors should be paid close attention to. Postoperative follow-up should be strengthened and early intervention should be carried out to reduce the recurrence probability of choledocholithiasis.

参考文献/References:

[1]Ruiz Pardo J,García Marín A,Ruescas García FJ,et al.Differences between residual and primary choledocholithiasis in cholecystectomy patients[J].Rev Esp Enferm Dig,2020,112(8):615-619.[2]Tazuma S.Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic)[J].Best Pract Res Clin Gastroenterol,2006,20(6):1075-1083. [3]Hori T.Comprehensive and innovative techniques for laparoscopic choledocholithotomy: A surgical guide to successfully accomplish this advanced manipulation[J].World Journal of Gastroenterology,2019,25(13):1531-1549. [4]Gu AD,Li XN,Guo KX,et al.Comparative evaluation of two laparoscopic procedures for treating common bile duct stones[J].Cell Biochem Biophys,2011,59(3):159-164. [5]Pan L,Chen M,Ji L,et al.The Safety and Efficacy of Laparoscopic Common Bile Duct Exploration Combined with Cholecystectomy for the Management of Cholecysto-choledocholithiasis: An Up-to-date Meta-analysis[J].Annals of Surgery,2018,268(2):247-253.[6]张建锋,李智,杨帆,等. LCBDE-LC与ERCP/EST-LC对胆囊结石合并胆总管结石的疗效比较[J].中国现代普通外科进展,2018,21(3):198-201.[7]刘立彬,杨连营,杜庆云,等.胆总管结石合并急性胆管炎患者PTCD胆汁与血培养病原菌分布及耐药性分析[J]. 中华医院感染学杂志,2019,29(5):726-729.[8]Parra-Membrives P,Martínez-Baena D,Lorente-Herce JM,et al.Choledocholithiasis recurrence following laparoscopic common bile duct exploration[J].Cirugia Espanola,2019,97(6):336-342.[9]Peng LJ,Cheng XN,Zhang L.Risk factors of stone recurrence after endoscopic retrograde cholangiopancreatography for common bile duct stones[J].Medicine,2020,99(27):e20412.[10]Zhang J,Ling X.Risk factors and management of primary choledocholithiasis: a systematic review[J].ANZ Journal of Surgery,2021,91(4):530-536.[11]Yoo ES,Yoo BM,Kim JH,et al.Evaluation of risk factors for recurrent primary common bile duct stone in patients with cholecystectomy[J].Scandinavian Journal of Gastroenterology,2018,53(4):466-470.[12]杨国华,杨照国,朱桂丽,等.胆总管结石术后复发风险因素研究[J].中华实验外科杂志,2018,35(7):1325-1327.[13]刘洪锋.十二指肠镜联合腹腔镜治疗胆囊结石并肝外胆管结石术后胆总管结石复发的高危因素分析[J].安徽医药,2018,22(5):904-907.[14]张荣,杨晓燕.注射用他唑巴坦钠/哌拉西林钠治疗新生儿感染的疗效观察[J].中国处方药,2016(2):59.[15]黄建伟.哌拉西林钠他唑巴坦钠致不良反应26例分析[J].临床合理用药杂志,2016,9(5):83-84.[16]边大鹏,冯秋实.复发胆总管结石伴随十二指肠乳头疾病的分析[J].外科理论与实践,2020,25(6):477-480.[17]李飞,廖玉芳,闫建华.临床药师参与1例哌拉西林他唑巴坦致药物热抗感染治疗方案调整临床分析[J].中国药业,2020,29(2):48-51.[18]Skar V,Skar AG,Bratlie J,et al.Beta-glucuronidase activity in the bile of gallstone patients both with and without duodenal diverticula[J].Scandinavian Journal of Gastroenterology,1989,24(2):205-212. [19]王利民,赵逸超,彭鹏,等.胆总管结石术后复发风险因素[J].世界华人消化杂志,2016,24(2):300-304.[20]余丽君,郏雪萍.胆总管结石患者ERCP取石术后复发的危险因素调查分析[J].中国卫生统计,2019,36(5):701-702.[21]孔艳杰.胆总管结石ERCP取石术后结石复发的危险因素分析[J].中国普通外科杂志,2015,24(6):899-902.

相似文献/References:

[1]杨文娟,罗豆豆,石益萌,等.胆囊结石与2型糖尿病的共病机制[J].医学信息,2018,31(20):27.[doi:10.3969/j.issn.1006-1959.2018.20.009]
　YANG Wen-juan,LUO Dou-dou,SHI Yi-meng,et al.The Comorbid Mechanism of Gallstones and Type 2 Diabetes Mellitus[J].Medical Information,2018,31(05):27.[doi:10.3969/j.issn.1006-1959.2018.20.009]
[2]王玉虎,韩双喜,高 娜.两种微创方案治疗胆囊结石并胆总管结石的疗效对比[J].医学信息,2019,32(07):126.[doi:10.3969/j.issn.1006-1959.2019.07.038]
　WANG Yu-hu,HAN Shuang-xi,GAO Na.Comparison of the Curative Effect of Two Minimally Invasive Methods In the Treatment of Cholecystolithiasis and Choledocholithiasis[J].Medical Information,2019,32(05):126.[doi:10.3969/j.issn.1006-1959.2019.07.038]
[3]铉 力,王晓红,胡 兵.大柴胡汤联合四金汤治疗肝胆湿热型胆总管结石的临床观察[J].医学信息,2019,32(07):166.[doi:10.3969/j.issn.1006-1959.2019.07.052]
　XUAN Li,WANG Xiao-hong,HU Bing.Clinical Observation of Dachaihu Decoction Combined with Sijin Decoction in Treating Hepatobiliary Damp-heat Choledocholithiasis[J].Medical Information,2019,32(05):166.[doi:10.3969/j.issn.1006-1959.2019.07.052]
[4]戴院华,罗四娥.腹腔镜联合输尿管镜治疗胆总管结石的临床疗效[J].医学信息,2019,32(10):117.[doi:10.3969/j.issn.1006-1959.2019.10.038]
　DAI Yuan-hua,LUO Si-e.Clinical Efficacy of Laparoscopic Combined with Ureteroscopy in the Treatment of Choledocholithiasis[J].Medical Information,2019,32(05):117.[doi:10.3969/j.issn.1006-1959.2019.10.038]
[5]高旭升,柳 杰,徐 峰,等.腹腔镜联合胆道镜胆总管探查取石术后胆管一期缝合与T管引流的疗效比较[J].医学信息,2019,32(24):94.[doi:10.3969/j.issn.1006-1959.2019.24.031]
　GAO Xu-sheng,LIU Jie,XU Feng,et al.Comparison of Curative Effects of Primary Bile Duct Suture and T-tube Drainage after Laparoscopy and Choledochoscopy[J].Medical Information,2019,32(05):94.[doi:10.3969/j.issn.1006-1959.2019.24.031]
[6]向红铭,易尚辉,吕 媛,等.铁路系统职工胆囊结石患病情况及其危险因素分析[J].医学信息,2020,33(05):126.[doi:10.3969/j.issn.1006-1959.2020.05.040]
　XIANG Hong-ming,YI Shang-hui,Lyu Yuan,et al.Prevalence of Cholecystolithiasis and Its Risk Factors in Railway System Workers[J].Medical Information,2020,33(05):126.[doi:10.3969/j.issn.1006-1959.2020.05.040]
[7]邸 亮,赵晓飞,丁 兢.腹腔镜联合术中胆道镜治疗胆囊结石合并肝外胆管结石的疗效[J].医学信息,2021,34(11):118.[doi:10.3969/j.issn.1006-1959.2021.11.032]
　DI Liang,ZHAO Xiao-fei,DING Jing.Treatment of Cholecystolithiasis with Extrahepatic Bile Duct Stones by Laparoscopy Combined with Intraoperative Choledochoscope[J].Medical Information,2021,34(05):118.[doi:10.3969/j.issn.1006-1959.2021.11.032]
[8]彭献景,陆学安.腹腔镜逆行胆囊次全切除术对慢性胆囊炎伴胆囊结石患者体液免疫功能的影响[J].医学信息,2022,35(03):118.[doi:10.3969/j.issn.1006-1959.2022.03.029]
　PENG Xian-jing,LU Xue-an.Effect of Laparoscopic Retrograde Subtotal Cholecystectomy on Humoral Immune Functionin Patients with Chronic Cholecystitis and Gallstones[J].Medical Information,2022,35(05):118.[doi:10.3969/j.issn.1006-1959.2022.03.029]
[9]俞卫铿.腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎患者临床疗效[J].医学信息,2022,35(17):110.[doi:10.3969/j.issn.1006-1959.2022.17.029]
　YU Wei-keng.Clinical Effect of Laparoscopic Cholecystectomy in Treatment of Patients with Gallstone and Chronic Cholecystitiss[J].Medical Information,2022,35(05):110.[doi:10.3969/j.issn.1006-1959.2022.17.029]
[10]曹园香.特定危机强化干预在高龄胆囊结石患者腹腔镜胆囊切除术中的应用效果[J].医学信息,2023,36(12):172.[doi:10.3969/j.issn.1006-1959.2023.12.036]
　CAO Yuan-xiang.Application Effect of Crisis-specific Intensive Intervention in Laparoscopic Cholecystectomy for Elderly Patients with Cholecystolithiasis[J].Medical Information,2023,36(05):172.[doi:10.3969/j.issn.1006-1959.2023.12.036]
[11]任海滨.微创手术治疗胆囊结石合并胆总管结石的临床疗效分析[J].医学信息,2018,31(02):107.[doi:10.3969/j.issn.1006-1959.2018.02.038]
　REN Hai-bin.Clinical Analysis of Minimally Invasive Surgery for Cholecystolithiasis Complicated by Choledocholithiasis[J].Medical Information,2018,31(05):107.[doi:10.3969/j.issn.1006-1959.2018.02.038]
[12]何 迎.Bulldog夹在三孔法腹腔镜保胆取石术中的应用分析[J].医学信息,2018,31(06):174.[doi:10.3969/j.issn.1006-1959.2018.06.063]
　HE Ying.Application of Bulldog Clip in Three-hole Laparoscopic Cholelithiasis Extraction[J].Medical Information,2018,31(05):174.[doi:10.3969/j.issn.1006-1959.2018.06.063]
[13]黄冬琴,吴 蔓.腹腔镜联合十二指肠镜及胆道镜在胆囊结石合并胆总管结石治疗中的应用[J].医学信息,2020,33(07):113.[doi:10.3969/j.issn.1006-1959.2020.07.034]
　HUANG Dong-qin,WU Man.Application of Laparoscopy Combined with Duodenoscope and Choledochoscope in the Treatment of Gallstones and Common Bile Duct Stones[J].Medical Information,2020,33(05):113.[doi:10.3969/j.issn.1006-1959.2020.07.034]
[14]陈晓东,乔阳波,周 伟.腹腔镜胆总管切开取石术对胆总管结石伴胆囊结石患者胃肠道功能的影响[J].医学信息,2023,36(10):158.[doi:10.3969/j.issn.1006-1959.2023.10.035]
　CHEN Xiao-dong,QIAO Yang-bo,ZHOU Wei.Effect of Laparoscopic Choledocholithotomy on Gastrointestinal Function in Patients with Choledocholithiasis and Cholecystolithiasis[J].Medical Information,2023,36(05):158.[doi:10.3969/j.issn.1006-1959.2023.10.035]
[15]曾志华.腹腔镜辅助下胆总管探查术及胆囊切除术治疗胆囊结石合并胆总管结石的效果[J].医学信息,2023,36(20):141.[doi:10.3969/j.issn.1006-1959.2023.20.028]
　ZENG Zhi-hua.Effect of Laparoscopic Common Bile Duct Exploration and Laparoscopic Cholecystectomy in the Treatment of Cholecystolithiasis Complicated with Calculus of Common Bile Duct[J].Medical Information,2023,36(05):141.[doi:10.3969/j.issn.1006-1959.2023.20.028]

更新日期/Last Update: 1900-01-01