腹腔镜胆囊切除术后发生胆管损伤的危险因素  

Risk factors for bile duct injury after laparoscopic cholecystectomy

作　　者：王锦江[1] 谢辉[1] WANG Jin-jiang;XIE Hui(Department of General Surgery,Yan an People's Hospital,Yan'an 716000,China)

机构地区：[1]延安市人民医院,陕西延安716000

出　　处：《腹腔镜外科杂志》2018年第12期898-900,共3页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜胆囊切除术(LC)后发生胆管损伤的危险因素,为临床预防胆管损伤的发生提供有效指导。方法:回顾分析2010年1月至2016年12月接受LC的608例患者的临床资料。根据术后有无胆管损伤分为胆管损伤组(n=28)与无损伤组(n=580)。分析患者临床资料及相关指标,主要包括性别、年龄、BMI、术前胆囊有无萎缩、术前胆囊壁厚度、术前胆囊管长度、胆囊三角解剖、胆囊炎症分期、术中出血、术中粘连、手术时间、胆囊管切断顺序等。应用单因素、多因素非条件logistic回归分析筛选与LC后胆管损伤相关的危险因素。结果:单因素logistic回归分析结果显示,两组患者在性别、年龄、术前胆囊萎缩、术前胆囊壁厚度、术前胆囊管长度、术者经验、胆囊三角解剖、胆囊炎症分期、术中出血、术中粘连、胆囊管切断顺序等方面差异有统计学意义(P<0.05),BMI、手术时间差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,胆囊三角解剖变异、术中粘连紧密、术者经验<100例是与LC术后胆管损伤相关的危险因素(P<0.05)。结论:胆囊三角解剖变异、术中粘连紧密、术者经验<100例与LC术后胆管损伤的发生密切相关。Objective:To explore the risk factors of bile duct injury after laparoscopic cholecystectomy(LC),and to provide effective clinical guidance for the prevention of the bile duct injury.Methods:The clinical data of 608 patients who underwent LC from Jan.2010 to Dec.2016 were retrospectively analyzed.According to the presence or absence of bile duct injury,the patients were divided into bile duct injury group(n=28)and non-injury group(n=580).Clinical data and related indicators were collected,including gender,age,BMI,preoperative gallbladder atrophy,the thickness of preoperative gallbladder wall,the length of preoperative gallbladder tube,gallbladder triangle anatomy,the stage of gallbladder inflammation,intraoperative blood loss,adhesion,operative time and the sequence of cystic duct resection.Univariate and multivariate unconditional logistic regression analysis were used to analyze the risk factors associated with bile duct injury after LC.Results:Univariate logistic regression analysis showed that there were significant differences in gender,age,preoperative gallbladder atrophy,the thickness of preoperative gallbladder wall,the length of preoperative cystic duct,surgeon experience,gallbladder triangle anatomy,the stage of gallbladder inflammation,intraoperative bleeding,intraoperative adhesions and the sequence of cystic duct resection between the two groups(P<0.05),the differences of BMI and operation time were not statistically significant(P>0.05).Multivariate unconditional logistic regression analysis showed that the anatomical variation of the gallbladder triangle,the tight adhesion during operation and the experience of the surgeon less than 100 cases were the risk factors of bile duct injury after LC(P<0.05).Conclusions:The anatomical variation of the gallbladder triangle,the tight adhesion during operation and the experience of the surgeon less than 100 cases are closely related to the occurrence of bile duct injury after LC.

关 键 词：胆囊切除术 腹腔镜 胆管损伤 因素分析 统计学 

分 类 号：R657.4[医药卫生—外科学]