| Objective: Laparoscopic choledocholithiasis combined with choledochoscope(LCBDE)is effective in the treatment of choledocholithiasis,but it still has a high postoperative recurrence rate.The recurrence of choledocholithiasis seriously affects the life of patients and increases their economic burden.However,there are still few drugs to prevent the recurrence of choledocholithiasis after choledocholithiasis.The First Affiliated Hospital of Da Lian Medical University integrated traditional Chinese and Western medicine in abdominal emergency surgery protocol internal prescription Qingre Lidan decoction and the hospital preparation made of Qingre Lidan Granules have achieved good results in the prevention and treatment of cholelithiasis related diseases over the years.Clinical use found that this drug has certain preventive effect on the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy.In this study,a retrospective cohort study was conducted to explore the preventive effect of Qingre Lidan Granules on the recurrence of choledocholithiasis after laparoscopic combined choledochoscopy.Methods: In this study,a retrospective cohort study was used to collect clinical data of hospitalized patients with choledocholithiasis(including cholecystolithiasis combined with laparoscopic choledochoscopy)diagnosed and treated in the First Affiliated Hospital of Da Lian Medical University from January 1,2010 to December 31,2020.All patients were followed up by checking outpatient revisit records and telephone calls,and patients meeting the inclusion and exclusion criteria were divided into exposed group(conventional treatment + Qingre Lidan Granules group)and non-exposed group(conventional treatment group)according to whether patients took Qingre Lidan granules after surgery.The related situation of stone recurrence in the two groups and the administration of Qingre Lidan granules in the exposed group were recorded in detail.By observing the recurrence rate of choledocholithiasis and the recurrence time of choledocholithiasis in the exposed group and the non-exposed group,the efficacy of Qingrelidan granules in preventing the recurrence of choledocholithiasis was evaluated,and the risk factors of choledocholithiasis recurrence after laparoscopy combined with choledochoscopy were analyzed.Results: A total of 337 patients met the inclusion and exclusion criteria,including 225 patients in the exposed group and 112 patients in the non-exposed group.The mean age of patients in the exposed group(64.8±14.8)was older than that in the non-exposed group(61.3±13.4),while the mean hospital stay of patients in the non-exposed group(15.5±5.9 days)was significantly longer than that in the exposed group(13.7±6.2 days),and the difference was statistically significant(P < 0.05).There were no significant differences in gender,past medical history and other data between the two groups(P > 0.05).After the comparison of operation-related and intraoperative conditions between the two groups,it was found that there were no statistically significant differences in the closure mode of the common bile duct,the site of incision,the number of stones seen in the two groups,the maximum diameter of the common bile duct,the maximum diameter of stones and the time of T-tube removal between the two groups(P > 0.05).In addition,there were no significant differences in the average values of WBC,ALT,AST,TBIL,DBIL and other liver function tests between the two groups at admission(P > 0.05).The serum ALP and γ-GT values in non-exposure group were higher than those in exposure group,and the difference was statistically significant(P < 0.05).After follow-up,a total of 26 patients with choledocholithiasis recurrence after laparoscopy combined with choledochoscopy were found,including 12 patients in the exposed group,with an overall recurrence rate of 5.33%.There were 14 patients in the non-exposure group,the overall recurrence rate was 12.5%,the difference was statistically significant(P < 0.05).The mean time of stone recurrence was 40.1±26.7 months in exposed group and 19.2±13.5 months in non-exposed group,and the difference was statistically significant(P < 0.05).In addition,Kplan-Meier survival analysis curve was used to compare the postoperative cumulative recurrence rates between the two groups,and it was found that the postoperative cumulative recurrence rates in different time periods were statistically different between the two groups(P < 0.05).Multivariate Logistic regression analysis showed that the diameter of the common bile duct ≥14mm(P=0.031,OR=2.935)and multiple calculi(P=0.029,OR=2.911)were independent risk factors for the recurrence of common bile duct calculi after laparoscopic choledochoscopy.Conclusions: 1.The recurrence rate of choledocholithiasis after laparoscopy combined with choledochoscopy was 5.33% in the exposed group and 12.5% in the non-exposed group,and the difference was statistically significant.These results indicate that Qingre Lidan granules can effectively reduce the recurrence rate of choledocholithiasis after laparoscopy combined with choledochoscopy,and have a certain role in preventing stone recurrence.2.In the exposed group,the average time of stone recurrence in patients with stone recurrence after laparoscopy combined with choledochoscopy is significantly longer than that in non-exposed patients,indicating that Qingrelidan granules can effectively prolong the time interval of stone recurrence in the common bile duct and slow down the process of stone formation.3.Multiple choledocholithiasis with diameter ≥14mm(P=0.031,OR=2.935,95%CI1.101-7.829)and multiple choledocholithiasis(≥2)were found through multivariate Logistic regression analysis(P=0.029,OR=2.911,95%CI1.118-7.584)is an independent risk factor for choledocholithiasis recurrence after laparoscopic choledochoscopy. |
