胆管炎型肝胆管结石病手术治疗预后分析  

Prognosis in patients with cholangitis type hepatolithiasis subject to surgical treatment

作　　者：孙士全 贾文俊[1] 毛谅[1] 周铁[1] 仇毓东[1] 

机构地区：[1]南京大学医学院附属鼓楼医院肝胆胰外科,南京210008

出　　处：《腹部外科》2015年第5期315-320,325,共7页Journal of Abdominal Surgery

基　　金：江苏省卫生厅医学重点人才项目（RC2011003）

摘　　要：目的 探讨胆管炎型肝胆管结石病行手术治疗的预后及影响其预后的相关因素.方法 回顾性分析2009年1月至2014年2月收治的胆管炎型肝胆管结石病行手术治疗病人的临床资料（共60例）.根据术后有无出现并发症分为并发症组（24例）和无并发症组（36例）,根据有无出现残留、复发结石或复发急性化脓性胆管炎分为复发组（16例）和无复发组（44例）,并进行统计学分析.结果 与无并发症组相比,并发症组病人在既往胆道手术史（Х^2=6.791）、术前碱性磷酸酶（ALP）、γ谷氨酰转移酶（GGT）、C反应蛋白（CRP）、前白蛋白（Pre-Alb）、手术时间（t=3.069）以及术中输血（Х^2=13.297）、术后胆汁或腹水细菌培养结果（Х^2=10.064）等方面差异均有统计学意义（P均＜0.05）;并发症组病人术后外源性白蛋白使用量增大、术后住院时间延长、住院费用明显增高（t值分别为2.312、6.916、5.519,P＜0.05）.多因素Logistic回归分析提示,术中输血、术后胆汁或腹水细菌培养结果是术后并发症的影响因素.与无复发组相比,复发组病人术前丙氨酸转氨酶、天冬氨酸转氨酶、ALP、GGT、总胆红素、直接胆红素、总胆汁酸、CRP、Pre-Alb（t值分别为6.348、8.946、9.113、8.466、5.579、5.458、11.196、11.447、-3.043）、肝胆管结石分型、肝切除范围（Х^2值为11.364、7.862）、手术时间、术中出血量（t值为-3.251、-3.115）及术中输血（Х^2=4.855）等方面差异均有统计学意义（P均＜0.05）.多因素Logistic回归分析提示,肝胆管结石分型、术前Pre-Alb、手术时间为术后残留、复发结石或复发急性化脓性胆管炎的独立风险因素.结论 对于接受手术治疗的胆管炎型肝胆管结石病,术中输血、术后胆汁或腹水细菌培养阳性的病人发生术后并发症的风险较高;弥漫型结石、术前血清Pre-Alb水平低以及手术时间短的病人残留、复发Objective To evaluate the prognosis in cholangitis type hepatolithiasis patients sub- ject to surgical treatment, and explore the related risk factors. Methods All clinical data from 60 cases of hepatolithiasis undergoing surgical treatment in Department of Hepatobiliary and Pancreas Surgery in Nanjing Drum Tower Hospital from Jan. 2009 to Feb. 2014 were retrospectively analyzed. Based on whether there were postoperative complications or recurrence [calculus remnant, relapse and acute suppurative cholangitis （ASC）], patients were divided into complication group （n = 24） and non-complication group （n = 36） or recurrence group （n = 16） and non-recurrence group （n = 44） for statistical analysis. Results There was significant difference in the history of biliary tract surgery, preoperative alkaline phosphatase （ALP）, gamma-glutamyl transpeptidase （C;T）, C reactive protein （CRP）, prealbumin （Pre-Alb） level, operating time, blood transfusion during operation, and results of postoperative bile or ascites bacterial culture between non-complication group and complication group （P 〈0. 05）. The use of exogenous albumin after operation was more, the length of hospital stay after oper- ation was longer and the cost of hospitalization was more in complication group than in non-complication group. Multiple Logistic regression analysis showed that blood transfusion during operation and the results of postoperative bile or ascites bacterial culture were the risk factors of postoperative complication. There was significant difference in preoperative alanine amino transferase, aspartate amino transferase, ALP, CA3T, total bilirubin, direct bilirubin, total bile acids, CRP, Pre-Alb level, type of hepatolithiasis, extent of liver resection, operating time, bleeding volume and the history of blood transfusion during operation between non-recurrence group and recurrence group （P〈0. 05）. Multiple Logistic regression analysis revealed the type of hepatolithiasis, preoperative Pre-Alb and op

关 键 词：肝胆管胆石 胆管炎 预后 

分 类 号：R657.42[医药卫生—外科学]