肝切除术治疗肝内胆管结石术后发生并发症的危险因素分析  

Risk factors of postoperative morbidity after hepatectomy for intrahepatic stones

作　　者：付顺军[1] 李绍强[1] 梁力建[1] 彭宝岗[1] 胡文杰[1] 林杰[1] 

机构地区：[1]中山大学附属第一医院肝胆外科,广州510080

出　　处：《中华肝胆外科杂志》2010年第5期325-327,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨肝切除治疗肝内胆管结石术后并发症的危险因素.方法 对中山大学附属第一医院近4年来择期行肝切除术的肝内胆管结石363例病人的临床资料进行回顾性分析.根据术后是否发生并发症分成两组,A组为并发症组（n=110）;B组为无并发症组（n=253）.对可能引起并发症的因素进行单因素和多因素统计分析.结果 本组因并发症病死2例,手术病死率为0.6%.110例病人术后出现并发症,发生率为30.3%.术后并发症包括：伤口感染/液化42例（11.6%）、胸腔积液41例（11.3%）、膈下积液36例（9.9%）、胆漏21例（5.8%）、腹腔积液/感染13例（3.6%）、消化道出血3例（0.8%）、胆道出血2例（0.6%）、肝功能衰竭1例（0.3%）.多因素分析结果 显示,既往胆道手术史（P=0.042,OR=0.617,95%CI：0.388～0.982）和手术时间（P=0.0001,OR=0.994,95%CI：0.991～0.997）是术后发生并发症的独立危险因素.结论 既往胆道手术史与手术时间的长短是影响肝内胆管结石肝切除术后并发症发生的独立危险因素.对既往有胆道手术史的病人充分的术前准备,提高手术技巧,仔细分离,尽量缩短手术时间是防止肝切除术后出现并发症的关键因素.Objective To study the risk factors of complications after hepatectomy for intrahepatic stone.Method Clinical data of 363 patients with hepatolithiasis receiving elected hepatic resection in past 4 years in our hospital were analyzed retrospectively.Postoperative complications were recorded.Possible risk factors pertaining to the development of complications were identified using univariate and multivariate analysis.Results the surgical mortality was 0.6%（2/363）.Postoperative complications occurred in 110 of 363 patients（30.3%）.The morbidity included wound infection/liquafication in 42 cases（11.6%）,pleural effusion in 41（11.3%）,subphrenic collection in 36 （9.9%）,bile leakage in 21（5.8%）,intra-abdominal collection/infection in 13（3.6%）,gastrointestinal bleeding in 3（0.8%）,biliary hemorrhage in 2（0.6%）,hepatic function insufficiency in 1 （0.3%）.The multivariate logistic regression analysis identified that previous history of biliary surgery （P=0.042,odds ratio[OR]=0.617,95%confidence interval[CI]：0.388 to 0.982）and operative time（P=0.0001,odds ratio[OR]=0.994,95%confidence interval[CI]：0.991 to 0.997）were the independent risk factors for development of complications after hepatoectomy for hepatolithiasis.Conclusion Previous history of biliary duct surgery and operative time are the independent risk factors for development of complications after hepatoectomy for intrahepatic stone.For patients with previous biliary surgery,adequate preoperative preparation,improving operative skills and shortening operative time are critical important to prevent occurrence of complications.

关 键 词：肝切除术 肝内胆管结石 并发症 

分 类 号：R657.3[医药卫生—外科学]