腹腔镜胆囊切除术后选择性腹腔引流患者延长引流时间的危险因素分析  

Analysis of the risk factors related to prolonged drainage time in patients with selective abdominal drainage after laparoscopic cholecystectomy

作　　者：葛新兰[1] 唐浩文[1] 曹俊宁[1] 潘可[1] 李崇辉[1] 刘博[1] Ge Xinlan;Tang Haowen;Cao Junning;Pan Ke;Li Chonghui;Liu Bo(Faculty of Hepato-pancreato-biliary Surgery,Chinese PLA General Hospital,Institute of Hepatobiliary Surgery of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院肝胆胰外科医学部解放军总医院肝胆外科研究所,北京100853

出　　处：《中华肝胆外科杂志》2022年第4期280-283,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨腹腔镜胆囊切除术后选择性腹腔引流患者引流时间大于1 d的危险因素。方法回顾性分析2009年11月至2019年11月在解放军总医院行腹腔镜胆囊切除术后选择性放置腹腔引流管患者的临床资料。共纳入233例患者,其中男性147例,女性86例,中位年龄59.0(47.5,65.5)岁。根据术后引流时间分为引流时间1 d组65例和引流时间大于1 d组168例。收集患者的基线资料和围手术期资料,分析引流时间大于1 d的危险因素。结果引流时间1 d组的引流时间1 d,引流时间大于1 d组的引流时间2~8 d。233例患者发生胆漏1例,发生腹腔出血14例,2~3 d后均自愈。233例选择性放置腹腔引流管的患者出院时均已痊愈。BMI≥28 kg/m^(2)(OR=3.443,95%CI:1.411~8.405,P=0.007)、手术时间≥65 min(OR=2.570,95%CI:1.310~5.045,P=0.006)、胆囊壁厚度≥0.5 cm(OR=12.720,95%CI:1.350~5.478,P=0.005)、术后腹痛(OR=13.537,95%CI:1.685~108.748,P=0.014)和术后发热(OR=8.156,95%CI:1.035~64.249,P=0.046)是引流时间大于1 d的独立危险因素。结论对于BMI≥28 kg/m^(2)、手术时间≥65 min、胆囊壁厚度≥0.5 cm、术后腹痛和发热的行腹腔镜胆囊切除术后选择性腹腔引流患者,临床医师应适当延长其引流时间,以确保医疗安全。Objective To determine the risk factors of drainage time longer than 1 day in patients with selective abdominal drainage after laparoscopic cholecystectomy.Methods The clinical data related to patients with selective abdominal drainage undergoing laparoscopic cholecystectomy from November 2009 to November 2019 at Chinese PLA General Hospital were retrospectively analyzed.Of 233 patients enrolled into this study,there were 147 males and 86 females,with a median aged 59.0(47.5,65.5)years old.The patients were divided into drainage time 1 day group of 65 patients and longer than 1 day group of 168 patients according to postoperative drainage time.The baseline data and perioperative data were collected,the risk factors correlated with drainage time longer than 1 day were analyzed.Results The drainage time was 1 in the 1 day group and 2~8 in another group.Among the 233 patients,there was one with biliary leakage and 14 patients had abdominal bleeding,all of them healed after 2~3 days.All of the 233 patients were recovered when discharged.Independent risk factors related to drainage time longer than 1 day include BMI≥28 kg/m^(2)(OR=3.443,95%CI:1.411-8.405,P=0.007),operation time≥65 min(OR=2.570,95%CI:1.310-5.045,P=0.006),thickness of gallbladder wall≥0.5 cm(OR=12.720,95%CI:1.350-5.478,P=0.005),postoperative stomachache(OR=13.537,95%CI:1.685-108.748,P=0.014)and postoperative fever(OR=8.156,95%CI:1.035-64.249,P=0.046).Conclusion For patients undergoing selective abdominal drainage after laparoscopic cholecystectomy with BMI≥28 kg/m^(2),operation time≥65 min,gallbladder wall thickness≥0.5 cm,postoperative abdominal pain and fever,clinicians should appropriately prolong the drainage time to ensure medical safety.

关 键 词：胆囊切除术 腹腔镜 选择性腹腔引流 引流时间 危险因素 

分 类 号：R657.4[医药卫生—外科学]