术前黄疸对胆总管结石患者急诊腹腔镜胆囊切除联合术中胆道取石术后并发症发生的影响  

Effect of preoperative jaundice on complications of laparoscopic cholecystectomy combined with intraoperative biliary stone removal in patients with common bile duct stones

作　　者：韩辉 郑康 HAN Hui;ZHENG Kang(Department of General Surgery, Baishui County Hospital, Baishui, Shaanxi 715600, P. R. China;Department of General Surgery, No.215 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi 712000, P. R. China)

机构地区：[1]白水县医院普通外科,陕西白水715600 [2]陕西省核工业二一五医院普通外科,陕西咸阳712000

出　　处：《中国普外基础与临床杂志》2019年第7期828-833,共6页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探索术前黄疸对胆总管结石患者急诊行腹腔镜胆囊切除联合胆总管取石术后并发症的影响。方法对2014年1月至2016年2月期间在白水县医院和陕西省核工业二一五医院因急性发作而急诊行腹腔镜胆囊切除联合术中胆道镜胆总管取石术的104例胆总管结石患者的临床资料进行回顾性分析,根据术前血清总胆红素水平将患者分为黄疸组(43例)和对照组(61例),比较2组患者术后并发症发生率的差异,并探索影响术后并发症发生的危险因素。结果黄疸组术后第1天的ALT和总胆红素水平均高于对照组(P<0.05),但黄疸组的住院时间短于对照组(P<0.001)。2组患者的总术后并发症率发生率和各并发症发生率(胆汁漏、胆道出血、高热、切口并发症及其他并发症)比较差异均无统计学意义(P>0.05),此外2组患者的Clavien-Dindo分级、并发症综合指数(CCI)值及CCI≥20患者的比例比较差异也均无统计学意义(P>0.05)。多因素分析结果显示:男性和残余结石是术后并发症发生的危险因素(P<0.05),而术前黄疸与术后并发症的发生的关系无统计学意义(P>0.05)。结论术前黄疸状态并不增加胆总管结石患者急诊行腹腔镜胆囊切除联合术中胆道镜胆总管取石术后并发症的发生风险。Objective To explore the effect of preoperative jaundice on the complications of laparoscopic cholecystectomy combined with intraoperative biliary stone removal in patients with common bile duct stones.Methods A total of 104 patients with choledocholithiasis who underwent laparoscopic cholecystectomy combined with intraoperative biliary stone removal for common bile duct stones in Baishui County Hospital and No.215 Hospital of Shaanxi Nuclear Industry between January 2014 and February 2016 were enrolled and retrospectively analyzed. The patients were divided into the jaundice group(43 cases) and the jaundice-free control group(control group, 61 cases)according to the preoperative serum total bilirubin level. The differences in postoperative complication rates between the two groups were compared and risk factors affecting postoperative complications were explored. Results The ALT and total bilirubin on the first day after operation in the jaundice group were higher than those in the control group(P<0.05).In addition, the hospital stay in the jaundice group was shorter than that of the control group(P<0.001). There was no significant difference in the incidence of total postoperative complication rate and the incidence of complications(included biliary leakage, ballistic hemorrhage, hyperthermia, incision complications, and other complications) between the two groups(P>0.05). There were no significant differences in Clavien-Dindo classification, comprehensive complication index(CCI), and ratio of CCI≥20(P>0.05). Multivariate analysis showed that male and residual stones were independently associated with postoperative complications(P<0.05), but there was no statistical correlation between preoperative jaundice and postoperative complications(P>0.05). Conclusion Preoperative jaundice does not increase the risk of complications after acute laparoscopic surgery in patients with common bile duct stones.

关 键 词：胆总管结石 黄疸 急诊手术 腹腔镜胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]