胆总管结石治疗后复发因素的研究进展

胆总管结石是外科最常见的良性疾病之一，随着科技的进步、医疗技术的提升以及医院硬件设施的完善，经内镜逆行性胰胆管造影术（ERCP）及腹腔镜胆总管探查术（LCBDE）已经成为胆总管结石的主要治疗手段，且具创伤小、恢复快的临床优势。但是，临床多中心研究数据显示，胆总管结石术后复发率为4%~24%，因此，胆总管结石术后复发是外科医生必须面对的挑战和亟待解决的问题。胆总管结石的形成是一个复杂的遗传和环境因素相互作用的过程，其具体机制尚未完全阐明，术后复发机制及相关因素亦成为临床研究的难点和热点。笔者通过整理归纳相关文献，从十二指肠乳头括约肌功能、胆道微生态、胆道解剖三个维度，阐述胆总管结石术后复发的相关机制与研究进展，为预防胆总管结石术后复发提供新的策略和研究方向。

Research progress on postoperative recurrence factors of choledocholithiasis

Choledocholithiasis is one of the most common benign surgical diseases. With the progress of science and technology, the development of medical techniques and the improvement of hospital hardware facilities, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) have become the main treatment methods for choledocholithiasis, with the clinical advantages of less trauma and rapid recovery. However, data from multicenter clinical trials showed that the postoperative recurrence rate of common bile duct stones is 4%-24%. Therefore, the postoperative recurrence of common bile duct stones is a challenge to be faced and an urgent problem to be solved for surgeons. The formation of choledocholithiasis is a complex process of the interactions between genetic and environmental factors, and its specific mechanism has not been fully clarified. The mechanism of postoperative recurrence and related factors have also become the challenges and hotspots of clinical research. Through literature review and extraction, the authors present the mechanism and research progress of postoperative recurrence of common bile duct stones from the three dimensionalities: duodenal papillary sphincter function, biliary microecology and biliary anatomy, so as to provide new strategies and research directions for preventing postoperative recurrence of choledocholithiasis.