肝内胆管结石患者肝切除术后感染性并发症发生的影响因素分析  

Risk factors for infectious complications after hepatectomy in patients with intrahepatic bile duct stones

作　　者：王新玮[1] 赵宗刚[2] WANG Xinwei ZHAO Zonggang(Department of General Surgery, The Fifth People＇s Hospital of Ji＇nan, Ji＇nan 250022, Chin)

机构地区：[1]济南市第五人民医院普外科,济南250022 [2]济南市第五人民医院内七科,济南250022

出　　处：《临床肝胆病杂志》2017年第9期1754-1757,共4页Journal of Clinical Hepatology

摘　　要：目的探讨肝切除治疗肝内胆管结石术后感染性并发症发生的相关危险因素。方法回顾性分析济南市第五人民医院2010年1月-2016年12月168例行肝切除术的肝内胆管结石患者的临床资料。对可能影响术后感染性并发症发生的危险因素先进行单因素分析,计数资料组间比较采用χ~2检验;将有统计学意义的因素进一步采用logistic多因素回归分析。结果 31例(18.5%)患者术后出现感染性并发症,无再手术病例,均治愈。单因素分析显示,年龄、术前Alb水平、合并胆汁性肝硬化、手术距急性胆管炎控制的时间间隔(ISAC)、肝切除术范围和胆肠吻合术是术后感染性并发症发生的影响因素(χ~2值分别为5.407、4.263、11.633、6.023、5.000、5.815,P值均<0.05);进一步多因素分析结果显示,合并胆汁性肝硬化[比值比(OR)=3.028,95%可信区间(95%CI):1.791~5.121,P=0.002]、ISAC<4周(OR=1.539,95%CI:1.010~2.345,P=0.046)、胆肠吻合术(OR=2.389,95%CI:1.261~4.527,P=0.028)是肝内胆管结石患者肝切除术后感染性并发症发生的独立危险因素。结论肝内胆管结石患者肝切除术后感染性并发症发生率较高,合并胆汁肝硬化、ISAC<4周、胆肠吻合术是其发生的独立危险因素,控制并改善这些因素有利于早期预防术后感染性并发症的发生。Objective To investigate the risk factors for infectious complications after hepatectomy in patients with intrahepatic bile duct stones. Methods A retrospective analysis was performed for the clinical data of 168 patients with intrahepatic bile duct stones who underwent hepatectomy in The Fifth People＇s Hospital of Ji＇nan from January 2010 to December 2016. A univariate analysis was performed for potential risk factors for infectious complications after hepatectomy,and the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for the factors with statistical significance. Results Of all patients,31（ 18. 5%） experienced infectious complications after surgery. No patient underwent reoperation and all patients were cured. The univariate analysis showed that age,preoperative albumin level,biliary cirrhosis,interval between surgery and acute cholangitis（ ISAC）,extent of hepatectomy,and choledochoenterostomy were influencing factors for postoperative infectious complications（ χ~2= 5. 407,4. 263,11. 633,6. 023,5. 000,and 5. 815,all P〈0. 05）. The multivariate analysis showed that biliary cirrhosis（ odds ratio [OR]= 3. 028,95% confidence interval [CI]： 1. 791-5. 121,P = 0. 002）,ISAC 4 weeks（ OR = 1. 539,95% CI： 1. 010-2. 345,P = 0. 046）,and choledochoenterostomy（ OR = 2. 389,95% CI： 1. 261-4. 527,P = 0. 028） were independent risk factors for infectious complications after hepatectomy in patients with intrahepatic bile duct stones. Conclusion Patients with intrahepatic bile duct stones,particularly those with biliary cirrhosis,ISAC 4 weeks,and choledochoenterostomy,have a high risk of developing infectious complications after hepatectomy. Control and improvement of these factors may help with the early prevention of postoperative infectious complications.

关 键 词：胆结石 肝切除术 手术后并发症 危险因素 

分 类 号：R657.42[医药卫生—外科学]