High Risk Factors For Primary Choledocholithiasis After Cholecystectomy

Background:Cholecystolithiasis is the most common disease in abdominal surgery.Because of the advantages of clear vision and fewer complications,laparoscopic cholecystectomy(LC)has been accepted and approbated by medical workers and patients,and with the development of laparoscopic technique,the skill of laparoscopic operation has been improved continuously,the difficulty of LC is reduced,which makes LC the first choice to treat gallstone.However,some patients will have common bile duct stones after cholecystectomy,which can be divided into secondary and primary,and most patients need multiple surgeries to solve common bile duct stones,which not only affects patients’ health,but also has a greater financial burden,and this phenomenon has caused high concern by doctors and patients.Primary choledocholithiasis after cholecystectomy can be defined as a patient who has had his gallbladder removed because of benign gallbladder diseases such as gallstones and gallbladder polyps had found stones in the common bile duct by imaging examination at least two years,in order to rule out secondary gallstones,we need except for gallstones with common bile duct stones,past or present hepatolithiasis gallstones,and gallstones into the common bile duct during cholecystectomy.The aim of this study was to investigate the high risk factors for primary choledocholithiasis after cholecystectomy,which is important for patients after cholecystectomy to prevent choledocholithiasis.Objective:We can explore the high risk factors of primary choledocholithiasis after cholecystectomy,and provide appropriate preventive and therapeutic measures for patients after cholecystectomy.Method:A retrospective analysis of 268 patients two years or more after cholecystectomy at the Jilin University of second hospital from January2012 to July 2020 was performed,there were 78 patients with primary choledocholithiasis after cholecystectomy and 190 patients without choledocholithiasis.We need collecte clinical data about age,sex,body mass index(BMI),hypertension,diabetes,smoking history,drinking history,surgical procedures,triglyceride,cholesterol,high-density lipoprotein,low-density lipoprotein,common bile duct dilation,glutamyl transpeptidase(GGT),alkaline phosphatase,total bilirubin,direct bilirubin and indirect bilirubin,and use single factor analysis and multiple factor analysis(logidtic regression)to calculate the difference,P<0.05 can be considered to have statistical significance.Results:There were no statistical significance(p>0.05)in sex,body mass index,hypertension,triglyceride,cholesterol,high-density lipoprotein,low-density lipoprotein,smoking history,drinking history and indirect bilirubin by single factor analysis(t test,chi-square test and non-parameter test of two independent samples),The factors with statistical significance(p<0.05)included: operation mode,diabetes,common bile duct dilatation,GGT,alkaline phosphatase,total bilirubin,direct bilirubin,age,these factors are suspected the influencing factor of primary choledocholithiasis after cholecystectomy.The clinical indexes that had no statistical significance by multiple factor analysis(p > 0.05)were: operation mode,diabetes,alkaline phosphatase,total bilirubin,direct bilirubin,age;The factors with statistical significance(p<0.05)were common bile duct dilatation and GGT.Conclusion:1.Common bile duct dilatation and GGT are independent risk factors for primary choledocholithiasis after cholecystectomy,and Patients after cholecystectomy with choledochal dilatation or GGT elevated,need to be closely observed,alert to the emergence of choledocholithiasis.2.These factors about age,sex,body mass index,hypertension,diabetes,surgical procedure,triglyceride,cholesterol,high-density lipoprotein,low-density lipoprotein,smoking history,drinking history,alkaline phosphatase,total bilirubin,direct bilirubin,and indirect bilirubin were not independent risk factors.