摘要
目的探讨腹腔镜胆总管探查联合一期缝合术治疗胆总管结石患者术后胆道并发症发生情况及其危险因素。方法收集2013年6月-2016年6月于咸阳市第一人民医院行胆总管探查联合一期缝合术的134例胆总管结石患者的临床资料,观察其胆道并发症,并按照Clavien-Dindo分级标准分级。对13个可能影响一期缝合术后胆道并发症的相关因素进行单因素分析,组间比较采用χ~2检验,采用logistic回归分析对筛选出的变量进行多因素分析。结果术后12例患者出现胆道并发症,发生率为8.96%,其中8例胆漏,2例胆道残留结石,1例胆道狭窄,1例胆道出血。按照Clavien-Dindo分级标准,Ⅰ级3例,Ⅱ级5例,Ⅲa级2例,Ⅲb级2例。单因素分析显示术后胆道并发症的发生与血浆Alb水平、再次胆道手术、鼻胆管引流及术者经验有关(χ~2值分别为4.012、4.942、4.336、5.975,P值均<0.05),而与年龄、性别、胆红素升高、结石最大直径、结石数目、合并内科疾病、合并胆囊结石、手术方式和缝合方式无关(P值均>0.05)。多因素分析显示,再次胆道手术和术者经验是术后胆道并发症发生的独立危险因素(χ~2值分别为6.448、6.842,P值均<0.05)。结论胆总管探查联合一期缝合术后仍存在一定的胆道并发症发生风险,其中以胆漏最常见,尤其是再次胆道手术及术者缺乏经验时。
Objective To investigate the incidence of biliary complications after laparoscopic common bile duct exploration combined with primary suture in the treatment of patients with common bile duct stones and related risk factors.Methods A total of 134 patients with common bile duct stones who underwent common bile duct exploration combined with primary suture in The First People＇s Hospital of Xianyang from June 2013 to June 2016 were enrolled,and biliary complications were evaluated according to the Clavien- Dindo classification.A univariate analysis was performed for 13 possible factors for biliary complications after primary suture,the chi- square test was used for comparison between groups,and a multivariate logistic regression analysis was performed for the factors screened out in the univariate analysis.Results A total of 12 patients experienced biliary complications after surgery,resulting in an incidence rate of 8.96%;among these patients,8 had bile leakage,2 had residual stones in the bile duct,1 had biliary stricture,and 1 had hematobilia.According to the Clavien- Dindo classification,3 had grade I,5 had grade II,2 had grade IIIa,and 2 had IIIb diseases.The univariate analysis showed that postoperative biliary complications were associated with plasma albumin level,biliary reoperation,nasobiliary drainage,and surgeon＇s experience（ χ^2= 4.012,4.942,4.336,and 5.975,all P〈0.05）,while they were not associated with age,sex,increased bilirubin level,maximum stone diameter,number of stones,medical diseases,gallstones,surgical procedure,and suture method（ all P〈0.05）.The multivariate analysis showed that biliary reoperation and surgeon＇s experience were independent risk factors for postoperative biliary complications（ χ^2= 6.448 and 6.842,both P〈0.05）.Conclusion There are certain risks of biliary complications after common bile duct exploration combined with primary suture,and biliary leakage is the most common complication,especially in patients undergoing biliary reoperation and when there is a lack of experience in surgeons.
出处
《临床肝胆病杂志》
CAS
2017年第2期304-307,共4页
Journal of Clinical Hepatology
关键词
胆总管结石
胆总管探查
一期缝合
手术后并发症
危险因素
choledocholithiasis
choledochotomy
primary closure
postoperative complications
risk factors
