摘要
目的探讨腹腔镜下胆总管切开取石一期缝合术后胆漏的独立危险因素,并做出相应预防策略;为临床行腹腔镜下胆道切开取石一期缝合提供帮助,减少术后胆漏的发生。方法回顾性分析我院肝胆外科在2019年至2023年收治的102例胆总管结石并行腹腔镜下胆道切开取石一期缝合手术患者的临床资料,根据患者术后是否发生胆漏分为胆漏组(n=18)和非胆漏组(n=84)。分析所有患者的一般资料、血清白蛋白、结石数目、胆总管直径、手术时间、术中出血量、缝合方式、主刀医生手术经验。通过单因素分析及多因素Logistic回归分析探索术后发生胆漏的危险因素,将危险因素指标纳入受试者工作特征(ROC)曲线进行分析。结果102例患者中18例患者出现胆漏,包括16例A级胆漏以及2例B级胆漏,对两组患者的临床资料行单因素及多因素Logistic回归分析结果显示:术者经验<30例,术前血清白蛋白低,使用连续性缝合的胆管缝合方式是患者术后发生胆漏的独立危险因素,差异有统计学意义(均P<0.05)。受试者工作特征(ROC)曲线分析结果:术前白蛋白水平界值为37.45 g/L(P<0.05)。结论术前血清白蛋白<37.45 g/L,连续缝合胆总管切口,术者手术经验<30例可作为预测腹腔镜下胆总管切开取石一期缝合术后发生胆漏的重要理论依据。
Objective To investigate the independent risk factors of bile leakage afteRlaparoscopic bile duct stone extraction with one-stage suturing and to develop prevention strategies to improve the clinical practice of laparoscopic bile duct stone extraction with one-stage suturing and reduce the incidence of postoperative bile leakage.Methods The clinical data of 102 patients admitted to ouRhospital from 2019 to 2023 with common bile duct stones and laparoscopic biliary resection with one-stage suture were retrospectively analyzed,and the patients were divided into bile leak group(n=18)and non-bile leak group(n=84)according to whetheRthey had bile leakage afteRsurgery.The general data,serum albumin,numbeRof stones,diameteRof common bile duct,operation time,intraoperative bleeding,suturing method,and surgical experience of the attending surgeon were analyzed in all patients.Risk factors foRpostoperative biliary leakage were explored by univariate analysis and multifactorial Logistic regression analysis,and risk factoRindicators were included in the subject work characteristics(ROC)curve foRanalysis.Results Among the 102 patients,18 patients developed bile leakage,induding 16 grade A bile leaks and 2 grade B bile leaks.The results of univariate and multivariate Logistic regression analysis of the clinical data of the two groups showed that:operatoRexperience<30 cases,low preoperative serum albumin,and the use of continuous suture bile duct closure were independent risk factors foRpostoperative bile leak,and the differences were statistically significant(all P<0.05).The results of the subject work characteristic(ROC)curve analysis:the cut-off value of preoperative albumin level was 37.45 g/L(P<0.05).Conclusion Preoperative serum albumin loweRthan 37.45 g/L,continuous sutured common bile duct incision,and operatoRsurgical experience<30 cases can be used as a significant theoretical basis foRpredicting bile leakage afteRlaparoscopic common bile duct dissection and lithotomy with one-stage suturing.
作者
陈广
黄川
丁兵
凌俊
张勇
蒋辉
Chen Guang;Huang Chuan;Ding Bing(Department of Hepatobiliary Surgery,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000;Department of Hepatobiliary Surgery,the Second People′s Hospital of Neijiang,Neijiang,Sichuan 641000,China.)
出处
《四川医学》
CAS
2024年第5期497-501,共5页
Sichuan Medical Journal
关键词
胆总管结石
腹腔镜下胆道切开取石一期缝合术
胆漏
危险因素
common bile duct
laparoscopic common bile duct dissection and lithotomy with one-stage suturing
bile leakage
risk factors
