Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Av/ Gaspar Aguilar 90, 46017, Valencia, Spain.
Faculty of Health Sciences, Valencian International University (VIU), C/ Pintor Sorolla 21, 46002, Valencia, Spain.
Langenbecks Arch Surg. 2022 Jun;407(4):1545-1552. doi: 10.1007/s00423-022-02577-7. Epub 2022 Jun 7.
Recurrence after common bile duct stone (CBDS) clearance is the major long-term drawback of their management. Its prevalence is significant, and it occurs after all primary therapeutic alternatives. The aim of this study was to determine the predictive factors associated with stone recurrence after surgical common bile duct exploration (CBDE).
A retrospective cohort study based on patients undergoing CBDE between 2000 and 2018 was conducted. Uni- and multivariate hierarchical regression analyses were performed to assess the independent predictive factors associated with recurrent CBDS in patients with initially successful surgery.
A total of 365 patients underwent successful surgical procedures. After a median follow-up of 43.2 (IQR 84) months, 31 (8.4%) patients were diagnosed with CBD stone recurrence. The median time to recurrence was 30.3 (IQR 38) months. The only variable associated with CBDS recurrence was preoperative endoscopic sphincterotomy (HR 2.436, 95% CI: 1.031-5.751, P = 0.042)).
Patients who undergo preoperative endoscopic sphincterotomy and then cholecystectomy with successful common bile duct clearance may be at increased risk for recurrent stone disease compared to those who go straight to surgery.
胆总管结石（CBDS）清除后复发是其长期管理的主要缺点。其发生率较高，所有主要治疗选择后均会发生。本研究的目的是确定与外科胆总管探查（CBDE）后结石复发相关的预测因素。
基于 2000 年至 2018 年期间接受 CBDE 的患者进行了回顾性队列研究。采用单因素和多因素分层回归分析评估与初始手术成功的患者中 CBD 复发相关的独立预测因素。
共有 365 例患者成功接受了手术。中位随访 43.2（IQR 84）个月后，31 例（8.4%）患者被诊断为 CBD 结石复发。复发的中位时间为 30.3（IQR 38）个月。唯一与 CBDS 复发相关的变量是术前内镜括约肌切开术（HR 2.436，95%CI：1.031-5.751，P=0.042）。
与直接手术相比，接受术前内镜括约肌切开术和随后成功胆总管清除术的患者可能有更高的复发性结石病风险。
