肝切除术后胆漏危险因素的多元回归分析  

Multivariate analysis for risk factors of bile leakage after hepatectomy

作　　者：程翔[1] 李科[1] 吴雨哲 郑启昌[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院肝胆外科,武汉430022

出　　处：《中华普通外科杂志》2013年第11期850-853,共4页Chinese Journal of General Surgery

摘　　要：目的探讨肝切除术后并发胆漏的危险因素。方法前瞻性的收集和回顾性分析我院2011年1月至2012年12月469例肝切除患者的临床资料，利用单因素回归分析筛选肝切除术后胆漏的相关因素，再用多元回归分析法对相关因素进行分析，明确独立危险因素。结果469例肝切术患者中术后胆漏106例，占22．6％。经单因素分析术后胆漏相关因素，包括男性、门静脉高压、脂肪肝、肝硬化、Child分级、术前腹水、手术时间、手术日总输液量、术中失血量、肝门阻断时间、术中微波热凝、术中淋巴结清扫、肝肿瘤数量、肿瘤边界、肿瘤包膜、肿瘤直径大小、肿瘤侵犯血管和腹腔引流管数量。多元回归分析发现，肝硬化[OR=13．2（2．3，76．9），P=0．004]、脂肪肝[OR=73．1（17．7，301．5），P〈0．001]、手术日总输液量[OR=1．0（1．0，1．0），P=0．019]和肿瘤最大直径[OR=1．2（1．1，1．3）P=0．003]是术后胆漏的独立危险因素。结论肝硬化，脂肪肝，手术日总输液量，和肿瘤最大直径是肝切除术后胆漏的独立危险因素。Objective To analyse risk factors for bile leakage after liver resection. Methods Between January 2011 and December 2012, 469 patients underwent elective hepatectomy. We prospectively collected and retrospectively analyzed demographic data, pathological variables, and perioperative variables. Univariate analysis screened the related factors of bile leakage after liver resection. Multivariate analysis identified the independent risk factors of postoperative bile leakage. Results 469 patients were included in the analysis. The prevalence of bile leakage was 22. 6% （n = 106）. Univariate analysis identified the following risk factors as male gender, portal hypertension, steatosis, cirrhosis, Child- Pugh grade, ascites, operative time, intraoperative transfusion, intraoperative blood loss, portal triad clamping, microwave solidification, lymphadeneetomy, number of tumor, tumor margin, tumor capsular, diameter of tumor, portal vein invasion or portal branch thrombosis, number of abdominal drains. Multivariate analysis identified 4 independent risk factors for postoperative bile leakage： Cirrhosis [ OR = 13.2 （2. 3, 76. 9） ,P = 0. 004 ], steatosis [ OR = 73.1 （ 17. 7, 301.5 ） ,P 〈 0. 0013, infusion volume of the surgery day [OR = 1.0 （1.0, 1.0）,P =0.019] and diameter of tumor ~OR = 1.2 （1.1,1.3）, P = 0. 003 ]. Conclusions Cirrhosis, steatosis, transfusion volume of the surgery day, and tumor size were risk factors for bile leakage after major liver resection.

关 键 词：肝切除术 胆漏 

分 类 号：R657.3[医药卫生—外科学]