Clinical Follow-up Results And Analysis Of Choledochoscopic Gallbladder-preserving Surgery

Objective:To understand the recurrence of stones in patients after choledochoscopic gallbladder-preserving cholecystolithotomy,to analyze the factors related to the recurrence of stones after choledochoscopic gallbladder-preserving cholecystolithotomy,and to evaluate the feasibility and effectiveness of choledochoscopic gallbladder-preserving cholecystolithotomy.Methods:Patients who underwent choledochoscopic gallbladder-preserving cholecystolithotomy at the Department of Hepatobiliary,Pancreatic and Splenic Surgery,First Hospital of Jilin University from June 2013 to December 2020 were included.Patients were selected according to the established inclusion criteria.The 214 patients were followed up clinically and analyzed,stone recurrence was recorded,relevant data were counted,and the recurrence rate,recurrence time,and relevant treatment after recurrence of gallbladder stones were analyzed,and risk factors related to recurrence were analyzed.Results:A total of 177 patients were followed up,with a follow-up rate of 82.71%（177/214）and a median follow-up time of 45.00（17.50-74.00）months.74 patients had stone recurrence in the follow-up,with a stone recurrence rate of 41.80%.The postoperative stone recurrence rate of patients with clear single stones from biliary stone extraction was 40.00%（44/110）,and the postoperative stone recurrence rate of patients with clear stones from biliary stone extraction was The postoperative stone recurrence rate in patients with clear stones was.Cholecystectomy was performed in 23 of the patients with recurrent stones,and the rest of the patients with recurrence were treated conservatively.The single-factor analysis of the factors affecting the recurrence of gallbladder stones after CGPC showed that BMI,family history,greasy diet,number of stones,and oral ursodeoxycholic acid were the factors affecting the recurrence of stones after CGPC;the multi-factor analysis of the clinical factors related to the recurrence of gallbladder stones after CPGC show that were statistically significant showed that family history,greasy diet,and number of stones were the factors affecting the recurrence of stones after CGPC and were independent influencing factors of stone recurrence after surgery.Conclusions:1.BMI,family history,greasy diet,number of stones,and oral ursodeoxycholic acid were influencing factors for stone recurrence after CGPC;among them,family history,greasy diet,and number of stones were independent influencing factors for stone recurrence after surgery.2.Preoperative evaluation of patients’ specific conditions,and endoscopic biliary stone extraction is not recommended for patients with definite gallbladder stones.3.Patients with a strong desire for biliary preservation should be evaluated with strict indications and detailed conversation,and a reasonable surgical plan should be selected to avoid secondary surgery due to high postoperative stone recurrence rate.