医源性胆管损伤行胆肠吻合术后近期并发症的危险因素分析  

Risk factors for early postoperative complications after hepaticojejunostomy for iatrogenic bile duct injury

作　　者：颜锡洋 薛鸿 陈江明[2] 谢胜学[1] 刘付宝[2] 黄强[3] 耿小平[1] Yan Xiyang;Xue Hong;Chen Jiangming;Xie Shengxue;Liu Fubao;Huang Qiang;Geng Xiaoping(Department of Hepatobiliary Surgeryy the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230031,China;Department of Hepatobiliary Surgery,Anhui Provincial Hospital,Hefei 230000,China)

机构地区：[1]安徽医科大学第二附属医院肝胆外科,合肥230601 [2]安徽医科大学第一附属医院肝胆外科,合肥230031 [3]安徽省立医院肝胆外科,合肥230000

出　　处：《中华普通外科杂志》2020年第8期628-632,共5页Chinese Journal of General Surgery

基　　金：安徽省重点研究与开发项目(1804h08020239)。

摘　　要：目的探讨医源性胆管损伤胆肠吻合术后近期并发症的发生率和相关危险因素.方法回顾性分析2001年至2018年在安徽医科大学第一附属医院和安徽省立医院接受胆肠吻合术的110例胆管损伤患者的病例资料.结果患者中位年龄44岁.术后近期并发症率为35.5%,严重并发症率为17.3%.单因素分析显示男性、转诊前手术修复、术中出血>400 ml和手术持续时间与术后近期并发症的发生显著相关(均P<0.05).多因素分析显示男性、转诊前手术修复、术前胆漏、联合肝部分切除和术中出血>400 ml是术后近期并发症发生的独立危险因素(均P<0.05).对术后近期严重并发症(Clavien-Dindo≥Ⅲ级)进行单因素和多因素分析后发现转诊前手术修复、联合肝部分切除和术中出血>400 ml均能显著影响术后近期严重并发症的发生(均P<0.05).而胆道修复的时机与并发症发生无显著性关联(P>0.05).结论发生胆管损伤后,原主刀医生应避免盲目即时行手术修复,尽早转诊至专科经验丰富的肝胆外科中心是最佳的选择.术前若持续存在胆漏,应优先充分引流胆汁控制感染.Objective To investigate the incidence and related risk factors related to early postoperative complications after hepaticojejunostomy surgery for iatrogenic bile duct injury.Methods A retrospective analysis was made on the data of 110 cases undergoing a hepaticojejunostomy at the First Affliated Hospital of Anhui Medical University and Anhui Provincial Hospital from January 2001 to December 2018.The univariate and multivariate analyses were performed to explore the impact risk factors on the short-term complications.Results Patients'median age was 44 years old.The short-term postoperative complication rate was 35.5%and the serious complication rate was 17.3%.Univariate analysis showed that male,a failed repair was attempted before referral,intraoperative bleeding>400 ml,.and duration of surgery were significantly related to the occurrence of early postoperative complications(all P<0.05).Multivariate analysis showed that male,pre-referral failed surgical repair,preoperative bile leakage,intially combined with hepatectomy,and intraoperative bleeding>400 ml were independent risk factors for postoperative short term complications(all P<0.05).Univariate and multivariate analysis of early postoperative severe complications(Clavien-Dindo≥Ⅲ)revealed that pre-referal surgical repair,combined liver resection,and intraoperative bleeding>400 ml can significantly affect the occurrence of early postoperative severe complications(all P<0.05).There was no significant correlation between the timing of biliary repair and the occurrence of complications(P>0.05).Conclusions Upon the occurrence of a referral hospital.If bile leakage persists before surgery,sufficient bile drainage should be given priority to control infection.

关 键 词：胆管 手术后并发症 胆肠吻合术 手术时机 

分 类 号：R657.4[医药卫生—外科学]