摘要
目的分析腹腔镜下胆囊切除术(LC)术后近期胆总管结石残留的危险因素,为临床防治提供参考。方法选取河南省南阳医学高等专科学校第一附属医院2014年1月-2016年1月收治的18例LC术后近期胆总管结石残留患者作为观察组,选取同期收治的320例LC术后近期未发生胆总管结石残留患者作为对照组。将2组患者在合并急性胰腺炎、ALT、AST、急诊手术、胆总管直径、逆行胆囊切除、术前磁共振胰胆管造影(MRCP)检查、DBil、充满型结石、胆囊结石数量、最小结石直径、胆囊容积、胆囊管直径、胆囊管长度及泥沙样结石等方面指标进行比较。计量资料2组间比较采用成组t检验,计数资料的组间比较采用χ~2检验,将有统计学意义的变量再进行logistic多因素回归分析。结果单因素分析结果显示合并急性胰腺炎、急诊手术、泥沙样结石、逆行胆囊切除、术前MRCP检查、胆囊结石数量、最小结石直径、胆囊容积、胆囊管直径及胆总管直径与LC术后近期胆总管结石残留具有相关性,差异均有统计学意义(χ~2值分别为9.801、16.217、5.802、9.865、5.145,t值分别为18.314、6.077、7.687、15.678、5.512,P值均<0.05);进一步行logistic多因素回归分析显示,合并急性胰腺炎、逆行胆囊切除、胆总管直径及胆囊管直径过大是LC术后近期胆总管结石残留的独立危险因素,而术前进行MRCP检查是其保护因素。结论对影响LC术后近期胆总管结石残留的相关危险因素进行积极干预,可最大限度减少术后胆管残余结石的发生。
Objective To investigate the risk factors for short- term residual common bile duct stones after laparoscopic cholecystectomy（ LC）,and to provide a reference for clinical prevention and treatment.Methods A total of 18 patients with short- term residual common bile duct stones after LC who were admitted to The First Affiliated Hospital of Nanyang Medical College from January 2014 to January 2016 were enrolled as observation group,and 320 patients without short- term residual common bile duct stones after LC who were admitted during the same period of time were enrolled as control group.The two groups were compared in terms of acute pancreatitis,alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,emergency surgery,results of preoperative magnetic resonance cholangiopancreatography（ MRCP）,direct bilirubin（ DBil）,the gallbladder full of stones,number of gallstones,minimum stone diameter,gallbladder volume,cystic duct diameter,cystic duct length,and sand- like stones.The independent- samples t test was used for comparison of continuous data between groups,the chi- square test was used for comparison of categorical data between groups,and a logistic multivariate regression analysis was performed for variables with statistical significance.Results The univariate analysis showed that acute pancreatitis,emergency surgery,sand- like stones,retrograde cholecystectomy,preoperative MRCP,number of gallstones,minimum stone diameter,gallbladder volume,cystic duct diameter,and common bile duct diameter were associated with short- term residual common bile duct stones after LC（ χ~2=9.801,16.217,5.802,9.865,and 5.145,t = 18.314,6.077,7.687,15.678,and 5.512,all P〈0.05）.The multivariate logistic regression analysis showed that acute pancreatitis,retrograde cholecystectomy,common bile duct diameter,and cystic duct diameter were independent risk factors for short- term residual common bile duct stones after LC,while preoperative MRCP was a protective factor.Conclusion Active intervention for risk factors for short- term residual common bile duct stones after LC can reduce the incidence of postoperative residual bile duct stones.
出处
《临床肝胆病杂志》
CAS
2017年第2期293-296,共4页
Journal of Clinical Hepatology
关键词
胆总管结石
胆囊切除术
腹腔镜
手术后并发症
危险因素
choledocholithiasis
cholecystectomy
laparoscopic
postoperative complications
risk factors
