Risk Factors For Recurrence Of Choledocholithiasis After ERCP Combined With LC In Patients With Choledocholithiasis And Cholecystolithiasis

Objective To study the risk factors for the recurrence of choledocholithiasis in patients with choledocholithiasis and cholecystolithiasis after endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.Methods From January 2008 to December 2016,the data of patients with choledocholithiasis and cholecystolithiasis in the First Affiliated Hospital of Soochow University were reviewed.The inclusion criteria in the study were that they were treated by laparoscopic cholecystectomy within one month after the removal of choledocholithiasis by ERCP and followed up.According to the diagnostic criteria of recurrent choledocholithiasis,the patients were divided into recurrence group and non-recurrence group.The independent risk factors for the recurrence of choledocholithiasis were studied by logistic regression analysis.Results A total of 167 patients were enrolled in the study with a follow-up period of 3 to 11 years.The recurrence of choledocholithiasis occurred in 39 patients and 26(66.7%)patients were male.The recurrence rate was 23.4%.After ERCP combined with LC,the recurrence of choledocholithiasis decreased year by year.The average age of the patients in the recurrence and non-recurrence group was 61.4±16.3 years and 55.2±15.9 years respectively.Univariate analysis showed that age(p=0.036),triglyceride(p=0.018),alanine aminotransferase(p=0.017),aspartate aminotransferase(p=0.044),albumin(p=0.044),positive bile bacterial culture(p<0.001),presence of periampullary diverticulum(p=0.001),diameter of common bile duct(p=0.005),size of choledocholithiasis(p=0.009)and the number of stones?2(p=0.002)were related to the recurrence of choledocholithiasis.Logistic regression analysis showed that diameter of common bile duct(OR=0.869,95%CI:0.764-0.988,p=0.033),the number of stones?2(OR=2.860,95%CI:1.292-6.331,p=0.010)and the positive bacterial culture of bile(OR=5.242,95%CI:2.099-13.091,p<0.001)were independent risk factors for the recurrence of choledocholithiasis.Conclusion After ERCP combined with LC,the recurrence rate of choledocholithiasis was 23.4%and the recurrent patients were mostly middle-aged and old people.The recurrence of choledocholithiasis decreased year by year.LC as early as possible was helpful to reduce the recurrence rate of choledocholithiasis.The diameter of common bile duct,the number of stones?2 and the positive bacterial culture of bile were independent risk factors for the recurrence of choledocholithiasis after ERCP and LC.