关键词: 胆总管结石； 腹腔镜； 胆道镜； 复发； 危险因素； 预测模型

Abstract: Objective To explore the risk factors for the recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy and to construct a predictive model.Methods A total of 296 patients with common bile duct stones who underwent laparoscopic combined with choledochoscopy for stone removal from January 2020 to October 2021 were selected for a 2-year follow-up.The patients were divided into a recurrence group and a non-recurrence group based on whether recurrence occurred.The clinical data of the two groups were compared. The factors with differences in the univariate analysis were subjected to Logistic multivariate analysis to obtain the risk factors for stone recurrence and construct a nomogram prediction model. The receiver operating characteristic curve (ROC), calibration curve and decision curve (DCA) were plotted for verification.Results After 2 years of follow-up,23 of the 296 patients (7.77%) had recurrence after laparoscopy combined with choledochoscopy, and 273 cases did not have recurrence (92.22%, non-recurrence group).The common bile duct diameter in the recurrence group (14.76±1.64)mm was longer than that in the non-recurrence group (12.32±1.41)mm. The proportion of history of biliary tract surgery in the recurrence group was 26.09%, and the proportion of hyperlipidemia was 39.13%, both higher than 3.30% and 15.38% in the non-recurrence group, and the differences were statistically significant (P < 0.05).Logistic regression analysis indicated that common bile duct diameter,history of biliary surgery,and hyperlipidemia were independent risk factors for recurrence of common bile duct stones (P<0.05).The Logistic regression equation and nomogram model were constructed as follows:Logit(P)=-16.614+1.008×common bile duct diameter+2.151×history of biliary surgery+1.361×hyperlipidemia.The ROC curve indicated that the model was reliable and stable (AUC=0.899,P<0.05),and the calibration and decision curves suggested that the model had good fit and clinical applicability.Conclusion The recurrence of choledocholithiasis after laparoscopy combined with choledochoscopy may be related to choledocholithiasis diameter,biliary duct operation history and hyperlipidemia.

Key words: choledocholithiasis; laparoscopy; choledochoscope; recurrence; risk factors; prediction model