胆总管探查引流术后T管窦道形成的相关因素分析  

Analysis of factors associated with T-tube sinus tract formation after common bile duct exploration and T-tube drainage

作　　者：汪建初[1] 浦涧[1] 王存川[3] 马日海[1] 路远[1] 卓臣义[1] 陆玉敏[2] 

机构地区：[1]右江民族医学院附属医院肝胆外科,广西百色533000 [2]右江民族医学院附属医院影像医学科,广西百色533000 [3]暨南大学微创外科研究所,广州510630

出　　处：《中华消化外科杂志》2015年第2期141-144,共4页Chinese Journal of Digestive Surgery

基　　金：广西卫生厅立项课题（Z2012719）

摘　　要：目的 通过螺旋CT检查胆总管探查引流术后T管窦道的形成,探讨影响窦道形成的相关因素.方法 回顾性分析2011年5月至2013年12月右江民族医学院附属医院收治的465例行胆总管探查引流术患者的临床资料,术后2周行T管造影检查,判断有无胆道残留结石及狭窄,行螺旋CT检查T管窦道是否形成.选择患者性别、年龄、Alb、C反应蛋白、ALT、TBil、Hb、手术方式、T管周围积液、再次手术、糖尿病11个可能会影响窦道形成的因素进行分析.单因素分析采用χ^2检验,多因素分析采用Logistic回归.结果 465例患者T管造影均通畅,且无残留结石;CT检查发现397例患者术后2周形成完整窦道,即行T管拔除.对于窦道形成不完整或未形成的患者,术后4周复查CT判断窦道形成后拔除T管.所有患者均无胆汁漏发生,痊愈出院.单因素分析结果显示：Alb、手术方式、T管周围积液、糖尿病是影响T管窦道形成的因素（χ^2=50.750,7.671,19.022,15.373,P＜0.05）;多因素分析结果显示：Alb＜ 30 g/L,腹腔镜手术、T管周围积液、糖尿病是影响T管窦道形成的独立危险因素（OR=1.135,0.493,0.262,0.363;95％CI：1.061 -1.214,0.280- 0.865,0.104-0.658,0.156 -0.843,P＜0.05）.结论 胆总管探查引流术后2周可通过CT检查判断T管窦道形成情况而决定是否拔除T管.Alb＜ 30 g/L、腹腔镜手术、T管周围积液、糖尿病是影响T管窦道形成的独立危险因素.Objective To explore the risk factors affecting T-tube sinus tract formation after common bile duct exploration and T-tube drainage by spiral computed tomography （SCT）examination.Methods The clinical data of 465 patients undergoing common bile duct exploration and T-tube drainage at the Affiliated Hospital of Youjiang Medical College for Nationalities from May 2011 to December 2013 were retrospectively analyzed.The residual stones and biliary stricture were detected by T-tube cholangiography,and the T-tube sinus tract formation in all the patients was detected by SCT examination at postoperative week 2.The factors affecting sinus tract formation were analyzed,including gender,age,albumin （Alb）,C-reactive protein,alanine transaminase （ALT）,total bilirubin （TBil）,hemoglobin （Hb）,surgical method,effusion around T tube,reoperation,diabetes.Univariate analysis was done using the chi-square test.Multivariate analysis was done using the Logistic regression.Results T-tubes of 465 patients were clear without residual stones.T-tube in the 397 patients was removed when the sinus tract formation was confirmed by CT examination at postoperative week 2.T-tubes in other patients were removed when the sinus tract formation was detected by CT reexamination at postoperative week 4.In univariate analysis,Alb,surgery method,effusion around T-tube and diabetes were important factors affecting T-tube sinus tract formation （χ^2 =50.750,7.671,19.022,15.373,P 〈 0.05）.Alb 〈 30 g/L,laparoscopic surgery,effusion around T-tube and diabetes were independent risk factors affecting T-tube sinus tract formation in multivariate analysis [Odds ratio =1.135,0.493,0.262,0.363; 95% confidence interval：1.061-1.214,0.280-0.865,0.104-0.658,0.156-0.843,P 〈 0.05].Conclusions The T-tube removal is determined according to the sinus tract formation by CT examination at week 2 after common bile duct exploration and T-tube drainage.Alb 〈 30 g/L,laparoscopic surgery,effusion around T-tube and diabetes are independent risk fact

关 键 词：胆道疾病 胆总管探查引流术 T管窦道 回归分析 

分 类 号：R657.4[医药卫生—外科学]