| Objective(s):To understand the therapeutic effect of endoscopic cholecystolithotomy,explore the influencing factors of gallbladder stone recurrence after cholecystolithotomy,and develop a risk prediction score model.Methods:Retrospective analysis was performed on the clinical data of 239patients who received endoscopic gallbladder preserving lithotomy in the Second ward of Gastrointestinal Surgery Department,the Second Affiliated Hospital of Kunming Medical University from January 2018 to December 2021.According to the inclusion and exclusion criteria,the remaining 182 patients were ultimately divided into a recurrence group of 22 patients and a non-recurrence group of 160 patients according to the postoperative stone recurrence of patients.Cumulative recurrence rate was calculated according to Kaplan-Meier curve.General characteristics(gender,age,nationality,education level,family history,pregnancy history,BMI,fatty liver,smoking history,drinking history),gallbladder and surgical characteristics(number of stones,stone size,gallbladder wall thickness,gallbladder systolic function,operative time,blood loss,preoperative pain history),preoperative biochemical and metabolic characteristics(TC,TG,LDL,HDL,Apo A1,Apo B,UA,FBG)and postoperative follow-up characteristics(balanced diet,regular diet,exercise habits,sedentary habits,medication compliance)among the groups of stone recurrence rate,meaningful factors into the Logistic multivariate regression model,Each independent risk factor was assigned to form a risk prediction score,and the ROC curve was used to evaluate the recurrence risk of the model.The model was divided into low-risk group and high-risk group according to the cutoff value,and Kaplan-Meier method was used to draw the cumulative recurrence curve of each group.Results:1.In 182 patients who underwent gallblade-preserving lithotomy,there were 22 cases of recurrence,with a recurrence rate of 12.1%.No gallbladder carcinoma was found during follow-up.The mean follow-up time was 28.7±12.0 months,the mean recurrence time was 15.6±9.5 months,and the median follow-up time was 29months.The cumulative recurrence rate of gallstones 1,2 and 3 years after minimally invasive gallbladder conservation was 6.6%,11.8%and 14.8%,respectively.2.Univariate analysis showed that:Fatty liver disease(χ~2=8.541,P<0.05),preoperative pain history(χ~2=10.117,P<0.05),the number of stones(χ~2=6.516,P<0.05),TG level(χ~2=10.188,P<0.05),the UA level(χ~2=4.401,P<0.05),dietary regularity(χ~2=7.088,P<0.05),exercise habits(χ~2=7.879,P<0.05),drug compliance(χ~2=14.610,P<0.05),and other factors significantly associated with stone recurrence.3.Multivariate analysis shows that:Multiple calculi(OR=4.918,P<0.05),TG≥1.71mmol/L(OR=4.724,P<0.05),irregular diet(OR=4.322,P<0.05)and poor medication compliance(OR=4.024,P<0.05)were independent risk factors for stone recurrence.4.Clinical prediction scores were established based on multivariate regression coefficients,and the efficacy of the scoring model was evaluated by ROC curves,which yielded an area under the curve of 0.839(95%CI:0.755-0.923,P<0.05),with an optimal predictive cutoff of 1.5,sensitivity of 0.864,and specificity of 0.681.According to the cutoff value,the patients were divided into low-risk group(≤1 point)and high-risk group(≥2 points).The cumulative recurrence rates in the first,second and third years of the low-risk group were 0.9%,1.9%and 4.7%,respectively,and the high-risk group were 15.8%,27.8%and 32.0%,respectively.The cumulative recurrence rate of low-risk group was significantly lower than that of high-risk group,and the difference between the two groups was statistically significant(P<0.05).Conclusion(s):1.The main problem after endoscopic gallbladderpreserving lithotomy is still stone recurrence,with an overall recurrence rate of 12.1%and no gallbladder carcinoma.2.This study found that a history of preoperative pain,a history of fatty liver,multiple stones,TG≥1.71mmol/L,UA≥428 mol/L,irregular diet,no exercise habit,and poor drug compliance were closely related to stone recurrence after gallstone preserving lithotomy..Among them,multiple calculi and TG≥1.71mmol/L were independent risk factors for stone recurrence.Regular diet and good medication compliance are independent protective factors for stone recurrence.3.The risk prediction score established in this study has certain guiding significance for the selection of preoperative gallbladder preservation indications and the prevention of postoperative stone recurrence.The patients with multiple gallstones combined with hypertriglyceridemia before operation should be careful to preserve gallbladder;Early diet adjustment and drug intervention should be given to the high-risk group of postoperative recurrence. |
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