腹腔镜胆囊切除术早期并发症的临床风险因素分析  

Clinical risk factors for early complications of laparoscopic cholecystectomy

作　　者：余锋[1] 田志强[1] 柏杨[1] 刘洪[1] 罗昆仑[1] 

机构地区：[1]南京军区腹腔镜外科中心/解放军第一0一医院肝胆外科,江苏无锡214044

出　　处：《中国普通外科杂志》2015年第8期1130-1134,共5页China Journal of General Surgery

摘　　要：目的:探讨腹腔镜胆囊切除术(LC)早期(术中与术后早期)并发症的危险因素,为其防范提供预警。方法:回顾2000年7月—2014年8月施行的16 032例行LC患者资料,分析患者的一般资料与早期并发症发生情况,对引起术后早期并发症的可疑因素行单因素分析筛选与多因素分析确认。结果:16 032例患者的平均年龄为(56.7±21.3)岁;男女比例为1:1.87,其中择期手术14 101例(88.0%),急诊手术1 931例(12.0%);发生早期并发症1 420例(8.9%)。单因素分析结果显示,性别、胆囊炎症情况、肥胖、上腹部手术史、急诊手术、手术持续时间、术者施行LC例数可能是影响LC术早期并发症的危险因素(均P<0.05);多因素Logistic回归分析结果显示,男性(OR=10.012,P=0.002)、胆囊急性炎症(OR=2.510,P=0.010)、BMI≥25 kg/m2(OR=3.105,P=0.023)、合并上腹部手术史(OR=7.882,P=0.030)和手术持续时间≥60 min(OR=8.634,P=0.001)是引起LC术早期并发症的独立风险因素。结论:男性、胆囊急性炎症、肥胖、上腹部手术史和长时间手术是LC术早期并发症的独立危险因素,对于具有这些因素的患者,术前及术后应采取积极措施预防其发生。Objective： To determine the risk factors for early complications （during or in early period after operation） of laparoscopic cholecystectomy （LC）, so as to provide warning signs for preventing such incidents. Methods： The records of 16 032 LC cases from July 2000 to August 2014 were reviewed. The general clinical variables and incidence of early complications were analyzed, and the suspicious factors for early complications were screened by univariate analysis and then verified by multivariate analysis. Results： Of the 16 032 patients, the average age was （56.7±21.3） years, male-to-female ratio was 1：1.87, 14 101 cases （88.0%） underwent elective LC and 1 931 （12.0%） cases underwent emergency LC and early complications occurred in 1 420 cases （8.9%）. Univariate analysis suggested that sex, inflammatory status of the gallbladder, obesiD3 history of upper abdominal surgery, emergency LCj operative duration, and number of LC operations the surgeon had performed were possible risk factors associated with the occurrence of early complications ofLC （P〈0.05）; Multivariable analysis revealed that male gender （0R=10.012, P=0.002）, acute cholecystitis （OR=2.S10, P=0.010）, BMI≥2S kg/m^2 （OR= 3.105, P=0.023）, history of upper abdominal surgery （0R=7.882, P=0.030） and operative duration 〉60 min （0R=8.634, P=0.001） were independent risk factors for occurrence of early complications of LC. Conclusion： Males, acute cholecystitis, obesity, history of upper abdominal surgery, and long operative time are independent risk factors for early complications of LC, and for patients with these factors, adequate pre- and postoperative measures should be taken to prevent the occurrence of these events.

关 键 词：胆囊切除术 腹腔镜 手术中并发症 手术后并发症 危险因素 

分 类 号：R657.4[医药卫生—外科学]