胆道良性疾病行胆管空肠吻合术后并发症的危险因素分析  

Risk factors of postoperative complications after hepaticojejunostomy for benign biliary diseases

作　　者：颜锡洋 陈江明[2] 李贺[1] 耿小平[2] Yan Xiyang;Chen Jiangming;Li He;Geng Xiaoping(Department of Emergency Surgery,the Second Affiliated Hospital,Anhui Medical University,Hefei 230601,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230088,China)

机构地区：[1]安徽医科大学第二附属医院急诊外科,合肥230601 [2]安徽医科大学第一附属医院肝胆外科,合肥230088

出　　处：《中华普通外科杂志》2022年第10期761-765,共5页Chinese Journal of General Surgery

摘　　要：目的探讨胆管空肠吻合术(hepaticojejunostomy,HJ)后胆漏率和严重并发症率及其相关危险因素。方法回顾性分析2003年1月至2017年12月期间因良性胆道疾病在安徽医科大学第一附属医院行HJ的病例资料,进行多因素分析寻找术后胆漏和严重并发症的相关危险因素。结果共283例患者接受了HJ,中位年龄39岁。术后近期并发症率为19.1%(n=54),胆漏率为11.7%(n=33),严重并发症率为15.2%(n=43)。多因素分析显示:术前脓毒症[OR=3.875,95%CI(1.583,9.485),P=0.003]、肝硬化[OR=3.212,95%CI(1.001,10.307),P=0.050]、术中出血≥400 ml[OR=6.054,95%CI(1.231,29.781),P=0.027]、术后住院≥9 d[OR=6.738,95%CI(2.287,19.855),P=0.001]是术后胆漏的独立危险因素;胆总管结石[OR=2.764,95%CI(1.174,6.510),P=0.020]、术前脓毒症[OR=4.310,95%CI(1.666,11.149),P=0.003]、术中出血≥400 ml[OR=5.944,95%CI(1.231,29.781),P=0.022]和术后住院≥9 d[OR=11.422,95%CI(1.317,49.859),P=0.001]为严重并发症的独立危险因素。结论HJ应在成功控制脓毒症、充分胆汁引流的情况下施行。术前需全面准确评估患者病情,严格把握肝部分切除手术指征。Objective To explore the postoperative biliary leakage and severe complication rate and its related risk factors of hepaticojejunostomy(HJ)for biliary disease.Methods The clinical data of patients undergoing HJ for benign biliary diseases at the First Affiliated Hospital of Anhui Medical University from Jan 2003 to Dec 2017 were retrospectively analyzed.Multi-factor analysis was used to find a risk factor for postoperative bile leakage and severe complications.Results Two hundred and eighty-three patients received HJ.The median age was 39 years.The short-term complication rate after surgery was 19.1%(n=54),and the biliary leakage rate was 11.7%(n=33),and the severe complication rate was 15.2%(n=43).By multi-factor analysis:preoperative sepsis[OR=3.875,95%CI(1.583,9.485),P=0.003],liver cirrhosis[OR=3.212,95%CI(1.001,10.307),P=0.050],intraoperative blood loss≥400 ml[OR=6.054,95%CI(1.231,29.781),P=0.027],postoperative hospitalization≥9 days[OR=6.738,95%CI(2.287,19.855),P=0.001]are the independent risk factors for postoperative bile leakage.Main bile duct stone[OR=2.764,95%CI(1.174,6.510),P=0.020],preoperative sepsis[OR=4.310,95%CI(1.666,11.149),P=0.003],intraoperative bleeding≥400 ml[OR=5.944,95%CI(1.231,29.781),P=0.022]and postoperative hospitalization≥9 days[OR=11.422,95%CI(1.317,49.859),P=0.001]are the independent risk factors for serious complications.Conclusions HJ should be conducted when the sepsis was under control and sufficient bile drainage.The patients'condition should be comprehensively and accurately assessed before operation.The indications for partial hepatectomy need to be strictly defined.

关 键 词：吻合术 外科 胆管 空肠 术后并发症 

分 类 号：R657.4[医药卫生—外科学]