Department of General Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 63-ro 10, Yeongdeungpo-gu, Seoul, 07345, Korea.
Department of Hepatobiliary and Pancreas Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Hepatobiliary Pancreat Sci. 2019 Dec;26(12):578-582. doi: 10.1002/jhbp.675. Epub 2019 Oct 29.
BACKGROUND: Recurrence of common bile duct stone (CBDS) is not common after laparoscopic common bile duct exploration (LCBDE). This study aimed to investigate the risk factors of recurrence of CBDS after LCBDE. METHODS: Patients who underwent LCBDE between January 2001 and December 2018 in four teaching hospitals of The Catholic University of Korea were included. The operation, fluoroscopy, and endoscopic retrograde cholangiopancreatography records were investigated retrospectively. The primary outcome of this study was the independent risk factors for recurrence of CBDS. RESULTS: A total of 230 patients were included in this study. Thirty-one patients had recurrence of CBDS. In univariate analysis, CBDS size (>9 mm) (P = 0.003), multiple stones (≥2) (P = 0.031), stone size (≥1.5 cm) (P = 0.041), CBD diameter (≥12 mm) (P = 0.005), CBD dilatation (≥10 mm) (P = 0.02), prior history of laparoscopic cholecystectomy (P = 0.002) were associated with recurrence. After multivariable logistic regression, CBDS size (>9 mm) (OR 4.67, 95% CI 1.35-16.18, P = 0.011), CBD dilatation (≥10 mm) (OR 5.66, 95% CI 1.47-21.82, P = 0.012), and prior history of laparoscopic cholecystectomy (AOR 3. 90, 95% CI 1.34-11.37, P = 0.013) were associated with recurrence. CONCLUSIONS: Stone size >9 mm, CBD diameter ≥10 mm, and prior history of laparoscopic cholecystectomy were risk factors for recurrence of CBDS after LCBDE.
背景:腹腔镜胆总管探查术(LCBDE)后胆总管结石(CBDS)复发并不常见。本研究旨在探讨 LCBDE 后 CBDS 复发的危险因素。
方法:纳入 2001 年 1 月至 2018 年 12 月在韩国天主教大学四所教学医院接受 LCBDE 的患者。回顾性调查手术、透视和内镜逆行胰胆管造影记录。本研究的主要结局是 CBDS 复发的独立危险因素。
结果:本研究共纳入 230 例患者,31 例患者 CBDS 复发。单因素分析显示,CBDS 大小(>9mm)(P=0.003)、多发结石(≥2 个)(P=0.031)、结石大小(≥1.5cm)(P=0.041)、CBD 直径(≥12mm)(P=0.005)、CBD 扩张(≥10mm)(P=0.02)、既往腹腔镜胆囊切除术史(P=0.002)与复发相关。多变量 logistic 回归后,CBDS 大小(>9mm)(OR 4.67,95%CI 1.35-16.18,P=0.011)、CBD 扩张(≥10mm)(OR 5.66,95%CI 1.47-21.82,P=0.012)和既往腹腔镜胆囊切除术史(AOR 3.90,95%CI 1.34-11.37,P=0.013)与复发相关。
结论:结石大小>9mm、CBD 直径≥10mm 和既往腹腔镜胆囊切除术史是 LCBDE 后 CBDS 复发的危险因素。
J Hepatobiliary Pancreat Sci. 2019-10-29
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