背景:自从在腹腔镜胆囊切除术中引入安全方法的批判性观点以来,胆总管的暴露,不建议使用肝总管,因此,胆囊管残余的长度不再受控制。本病例对照研究的目的是评估胆囊管残余长度与胆囊切除术后胆管结石复发风险之间的关系。
方法:回顾了2010年至2020年之前接受胆囊切除术的患者的所有具有胆道专用序列的MRI。使用多变量逻辑回归分析,测量并比较有和没有胆管结石的患者的胆囊管残余长度。
结果:本研究共纳入362例患者,其中23.5%的人在MRI上有胆管结石。结石患者的胆囊管残留明显长于对照组(中位数31mm对18mm,P<0.001)。在胆囊切除术后>2年的MRI中,胆管结石患者的胆囊管残留也明显更长(中位数为32mm对21mm,P<0.001)。长度≥15mm的胆囊管残留会增加结石的几率(OR=2.3,P=0.001)。总的来说,胆管结石的几率随着胆囊管残余长度的增加而增加(≥45mm,OR=5.0,P<0.001)。
结论:胆囊管残余长度过长会增加胆囊切除术后胆管结石复发的几率。
Since the introduction of the Critical View of Safety approach in laparoscopic cholecystectomy, exposure of the common bile duct, and common hepatic duct is not recommended, therefore, the length of the cystic duct remnant is no longer controlled. The aim of this case‒control
study is to evaluate the relationship between the length of the cystic duct remnant and the risk for bile duct stone recurrence after cholecystectomy.
All MRIs with dedicated sequences of the biliary tract taken between 2010 and 2020 from patients who underwent prior cholecystectomy were reviewed. The length of the cystic duct remnant was measured and compared between the patients with and without bile duct stones using multivariate logistic regression analysis.
A total of 362 patients were included in this
study, 23.5% of whom had bile duct stones on MRI. The cystic duct remnant was significantly longer in the patients with stones than in the control group (median 31 mm versus 18 mm, P < 0.001). In the MRIs performed > 2 years after cholecystectomy, the cystic duct remnant was also significantly longer in the patients with bile duct stones (median 32 mm versus 21 mm, P < 0.001). A cystic duct remnant ≥ 15 mm in length increased the odds of stones (OR = 2.3, P = 0.001). Overall, the odds of bile duct stones increased with an increasing cystic duct remnant length (≥ 45 mm, OR = 5.0, P < 0.001).
An excessive cystic duct remnant length increases the odds of recurrent bile duct stones after cholecystectomy.