腹腔镜下经胆囊管汇入部微切开胆道探查术后胆漏的危险因素分析  

Analysis of risk factors of bile leakage after laparoscopic transcystic common bile duct exploration through the micro-incision approach

作　　者：陈晓燕[1] 沈世强[1] Chen Xiaoyan;Shen Shiqiang(Department of Hepatobiliary ＆ Laparoscopic Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肝胆腔镜外科,武汉430060

出　　处：《腹部外科》2018年第5期349-353,共5页Journal of Abdominal Surgery

摘　　要：目的探讨腹腔镜下经胆囊管汇入部微切开胆道探查术后胆漏的危险因素。方法收集2012年3月至2017年8月期间就诊于武汉大学人民医院行腹腔镜下经胆囊管汇入部微切开胆道探查术的146例病人的临床资料,根据术后是否发生胆漏分为2组,胆漏组(14例)和非胆漏组(132例),对围术期可能导致胆漏发生的危险因素进行单因素分析及二分类Logistic多因素分析。结果术后14例(9.6%)病人发生了不同程度的胆漏,均经不同的治疗方式治愈。单因素分析发现两组间术前白蛋白水平、手术时间、胆囊管结石嵌顿、胆囊三角严重粘连、术者经验差异具有统计学意义,多因素二分类Logistic回归结果显示术前白蛋白<35g/L、胆囊管结石嵌顿、胆囊三角严重粘连及术者经验相对不成熟均为病人术后胆漏发生的独立危险因素。结论术前白蛋白<35g/L、胆囊管结石嵌顿、胆囊三角严重粘连及术者经验相对不成熟是胆漏发生的独立危险因素,术前对病人进行营养评估,纠正不良营养状态,术后精细操作,可有效降低术后胆漏发生的概率。Objective To explore the risk factors of bile leakage after laparoscopic transcystic common bile duct exploration（LTCBDE）through the micro-incision approach in the confluence of cystic duct and common bile duct（CBD）.Methods The clinical data of 146 patients experiencing LTCBDE through the micro-incision approach from March 2012 to August 2017 in Renmin Hospital of Wuhan University collected,and statistical analysis was performed.Results Of all the 146 patients,the incidence of bile leakage was 9.6%,and there was no perioperative mortality.The univariate analysis revealed that there was significant difference in the level of ALB,operation time,incarcerated cystic duct calculi,the adhesion of Calot＇s triangle and the inexperienced surgeon between two groups.The multivariate analysis showed hypoproteinemia（ALB〈35 g/L）,incarcerated cystic duct calculi,the adhesion of Calot＇s triangle and the inexperienced surgeon were the independent risk factors of bile leakage.Conclusions The hypoproteinemia（ALB〈35 g/L）,incarcerated cystic duct calculi,adhesion of Calot＇s triangle and the inexperienced surgeon are the independent risk factors of bile leakage.Preoperative nutrition screen and support and intricate technique by experienced surgeon may greatly decrease the incidence of bile leakage after LTCBDE through the micro-incision approach in the confluence of cystic duct and common bile duct.

关 键 词：胆漏 胆囊管汇入处微切开 腹腔镜 胆总管探查 危险因素 

分 类 号：R657.42[医药卫生—外科学]