Analysis Clinical Efficacy And Gallstones Recurrence Factors Of New Surgery Of Removing Gallstones And Preserving Gallbladder

Objective:To analysis the clinical efficacy and to discuss the gallstones recurrence factors of postoperative mini-invasive surgery of removing gallstones and preserving gallbladder through laparoscope combined with choledochoscope.Methods:Clinical data of 704 patients with gallstones treated with mini-invasive surgery of removing gallstones and preserving gallbladder through laparoscope combined with choledochoscope in our hospital between February 2009 and February 2012 were analyzed retrospectively.About641 patients that consistent with this study were divided into the recurrence groups and the non-recurrence group according to follow-up results.Clinical data and follow-up data were analysed by SPSS17.0 statistical software.Measurement data were dealt with T test.Count data were dealt with chi-square test.If P<0.05 that was considered statistically significant.The relevant factors of postoperative recurrence of stones were dealt with Logistic regression.If OR>1 that was considered to be a risk factor.Results:In 704 patients with gallstone,the cases of single stone was 318,the number of two stones was 94,the number of three or above three stones was 292.The largest number of stone was more than ten.The diameter of the stone was from 2mm to 35 mm and the average diameter was13.8±6.7mm.There were 11 cases sandy stones found in sediment.Because of the number of calculi was so much that we couldn’t statistical measured.Operation time was from30 min to 63 min, the average time was 37±8.4min.Blood loss was from 5ml to 15 ml,average Blood loss was 11±2.7ml.Postoperative hospital stay was from 2d to 5d.The recurrence rate of laparoscopic and choledochoscopic cholecystolithotomy was 4.5% in postoperative 3-6 years.641 cases were contend in this study.29 cases were in recurrence group.612 cases were in no recurrence group.Single factor analysis showed that history of acute cholecystitis attacks and the number of gallbladder stone have correlation with postoperative gallbladder stone recurrence(χ2 = 10.765, p < 0.01; χ2 = 6.457, 0.01 < p <0.05);Logistic regression results showed the history of cholecystitis attacks and more three gallstones were risk factors for the development of gallbladder stone recurrence after surgery(P=0.001,OR=3.626,95%CI=1.653-7.953;P=0.015,OR=3.014,95%CI=1.238-7.337).Conclusion:Endoscopic minimal invasive cholecystolithotomy with gallbladder reservation was safe and feasible and had great practical value and good prospects, but the history of acute cholecystitis and more than three gallstones were risk factors for the development of gallbladder stone recurrence after cholecystolithotomy with gallbladder reservation.The patients with a history of acute cholecystitis and more than three gallstones should keep cautious to receive cholecystolithotomy with gallbladder reservation.