Department of Surgery, College of Medicine, Chung-Ang University, Seoul, South Korea.
Department of Internal Medicine, College of Medicine, Chu ng-Ang University, 224-1 Heuksuk-dong, Dongjak-gu, 156-755, Seoul, South Korea.
Surg Endosc. 2017 Nov;31(11):4857-4862. doi: 10.1007/s00464-017-5698-3. Epub 2017 Jun 29.
The development of common bile duct (CBD) stones after laparoscopic cholecystectomy (LC) could be a stressful event for surgeons and patients. The purpose of this study was to investigate the risk factors for and the time of occurrence of CBD stones, which are detected at a certain period after LC in patients who have no history of having CBD stone before operation.
A total of 1938 patients who underwent LC for benign gallbladder lesion were retrospectively analyzed. The patients were categorized into two groups according to the development of CBD stones at least 6 months after LC (case group, control group). The risk factors for and the time of development of CBD stones after LC were evaluated.
In a univariate analysis, the significant factors for the development of CBD stones were old age, acute cholecystitis, the presence of periampullary diverticulum, and the presence of gall bladder stones sized <0.55 cm. By multivariate analysis, acute cholecystitis (OR: 3.082, 95% CI: 1.306-7.272, p = 0.010), the presence of periampullary diverticulum (OR: 7.950, 95% CI: 3.425-18.457, p < 0.001), and the presence of gall bladder stones sized < 0.55 cm (OR: 5.647, 95% CI: 1.310-24.346, p = 0.020) were independent factors that could predict the development of CBD stones at least 6 months after LC. The time intervals of the development of CBD stones had evenly distributed during 50 months after LC.
This study suggested that the surgeon should inform the possibility of the development of CBD stones who have the identified risk factors.
腹腔镜胆囊切除术（LC）后胆总管（CBD）结石的发展可能是外科医生和患者的一个压力事件。本研究旨在探讨在无 CBD 结石病史的患者中，LC 后至少 6 个月时发现 CBD 结石的危险因素和发生时间。
回顾性分析 1938 例因良性胆囊病变行 LC 的患者。根据 LC 后至少 6 个月 CBD 结石的发展情况，将患者分为两组（病例组，对照组）。评估 LC 后 CBD 结石发展的危险因素和时间。
单因素分析显示，CBD 结石发展的显著因素为年龄较大、急性胆囊炎、壶腹周围憩室存在和胆囊结石大小<0.55cm。多因素分析显示，急性胆囊炎（OR：3.082，95%CI：1.306-7.272，p=0.010）、壶腹周围憩室存在（OR：7.950，95%CI：3.425-18.457，p<0.001）和胆囊结石大小<0.55cm（OR：5.647，95%CI：1.310-24.346，p=0.020）是预测 LC 后至少 6 个月 CBD 结石发展的独立因素。CBD 结石发展的时间间隔在 LC 后 50 个月内均匀分布。
本研究提示外科医生应告知有明确危险因素的患者 CBD 结石发展的可能性。
