Risk Factor Analysis For Cholecystoenteric Fistula In Cholelithiasis And Clinical Observation Of Laparoscopic Therapy On Cholecystoenteric Fistula

Objective: The aim of this study is to investigate the risk factor of cholecystoenteric fistula in cholelithiasis based on MIMIC-Ⅳ database and assess the clinical efficacy and prognosis of laparoscopic therapy of cholecystoenteric fistula and compare the advantages and limitations of laparoscopic and open treatment.Methods: The data of patients diagnosed with gallstones and cholecystoenteric fistula were extracted from MIMIC-Ⅳ database,and univariate and multivariate analyses were performed.We reviewed the patients with cholecystoenteric fistula in Shengjing Hospital of China Medical University from January 2011 to August 2022.According to treatment,patients were divided into laparoscopic group(n=13)and open group(n=15).The medical records were reviewed for basic information,perioperative laboratory test results,operation time,intraoperative blood loss,intraoperative treatment of fistula,postoperative drainage time,drainage volume,gastrointestinal function recovery,complications,postoperative hospital stay and hospitalization costs.Results: Low serum albumin [OR(95%CI)=0.997(0.995-0.999),P=0.003] and abnormal gallbladder or bile duct malformation [1.06(1.042-1.078),P<0.001] were independent risk factors for cholecystoenteric fistula in patients with gallstones.There were no significant differences between the two groups in basic condition,preoperative laboratory test results,operation time,intraoperative blood loss,gastrointestinal function recovery and complications(P<0.05);The duration of postoperative drainage in the laparoscopic group was significantly less than that in the open group [7(7,8.5)vs.11(10,20),P=0.006].The postoperative drainage volume in the laparoscopic group was significantly less than that in the open group [202(113,322)vs.630(298,1853),P=0.01].The postoperative hospital stay in the laparoscopic group was significantly shorter than that in the open group [8(8,10)vs.15(13,25),P<0.001].The total cost of hospitalization in the laparoscopic group was significantly lower than that in the open group [42008.49(33791.88,51006.65)vs.70343.14(58147.72,88964.55),P<0.001].Conclusions: Low serum albumin and gallbladder or bile tract malformation are independent risk factors for cholecystoenteric fistula in cholelithiasis.Laparoscopic therapy is safe and feasible in the treatment of patients with cholecystoenteric fistula.However,the choice of surgical schemes still needs to be individualized.