急性胆囊炎患者腹腔镜术后胆管损伤的影响因素分析  

Logistic regression analysis of risk factors of bile duct injury in patients with acute cholecystitis after laparoscopic surgery

作　　者：李炯[1] 曹淑洋 李训海[1] Li Jiong;Cao Shuyang;Li Xunhai(Department of General Surgery,Zhengzhou First People's Hospital,Henan 450000,China)

机构地区：[1]河南省郑州市第一人民医院普外科,450000

出　　处：《淮海医药》2022年第6期570-572,577,共4页Journal of Huaihai Medicine

摘　　要：目的:探究急性胆囊炎患者腹腔镜术(LC)后发生胆管损伤的影响因素。方法:选取某院2017年1月—2021年11月行LC的急性胆囊炎患者186例为研究对象,根据术后是否发生胆管损伤,分为损伤组(15例)和非损伤组(171例)。比较2组患者基线资料包括性别、年龄、吸烟史、积液情况、肝功能、糖尿病、冠心病、高血压、胆囊三角解剖及胆囊壁厚度等,采用多因素Logistic回归方法分析急性胆囊炎患者LC后发生胆管损伤的影响因素,绘制受试者工作特征(ROC)曲线评价Logistic回归方程对急性胆囊炎患者LC后发生胆管损伤影响因素的预测价值。结果:单因素分析显示,2组间性别、年龄、吸烟史、积液情况、肝功能、糖尿病、冠心病、高血压、胆囊合并症、胆囊管切断顺序及手术时间比较,差异无统计学意义(P>0.05);2组间胆囊三角解剖、胆囊壁厚度、术中粘连、胆囊管长度、Calot三角充血及Calot三角水肿比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,胆囊三角解剖变异、胆囊壁厚度>4 mm、术中粘连、胆囊管长度≤10 mm、Calot三角充血及Calot三角水肿均为急性胆囊炎患者LC后发生胆管损伤的独立危险因素(OR>1,P<0.05)。ROC曲线显示,Logistic回归模型对急性胆囊炎患者LC后发生胆管损伤的预测AUC为0.867(95%CI:0.824~0.936),敏感度为80.45%,特异度为89.52%。结论:急性胆囊炎患者LC后发生胆管损伤的独立危险因素包括胆囊三角解剖变异、胆囊壁厚度>4 mm、术中粘连、胆囊管长度≤10 mm、Calot三角充血及Calot三角水肿,临床中应制定精准化方案,减少LC后发生胆管损伤的风险。Objective:To investigate the incidence and influencing factors of bile duct injury in patients with acute cholecystitis after laparoscopic cholecystectomy(LC).Methods:186 patients with acute cholecystitis treated with LC in our hospital from January 2017 to November 2021 were selected as the study objects. According to whether bile duct injury occurred after surgery, they were divided into an injury group(15 cases)and a non injury group(171 cases).The baseline data of the two groups of patients were collected, and the influencing factors of bile duct injury in patients with acute cholecystitis after LC were analyzed by single factor and logistic multi factor analysis, and the predictive value of logistic regression equation on the influencing factors of bile duct injury in patients with acute cholecystitis after LC was evaluated by using the ROC curve of the subjects.Results:Among the 186 patients with acute cholecystitis, 15(8.06%) had bile duct injury after LC;Univariate analysis showed that there were significant differences between the two groups in terms of the anatomy of gallbladder triangle, thickness of gallbladder wall, intraoperative adhesion, length of cystic duct, Calot triangle congestion, and Calot triangle edema(P<0.05);Logistic multivariate analysis showed that the anatomy of gallbladder triangle, thickness of gallbladder wall(>4 mm),intraoperative adhesion, length of cystic duct(≤10 mm),Calot triangle congestion, and Calot triangle edema were independent risk factors for bile duct injury in patients with acute cholecystitis after LC(OR>1,P<0.05);ROC curve showed that the predictive AUC of the logistic regression model for bile duct injury after LC in patients with acute cholecystitis was 0.867(95% CI:0.824~0.936),sensitivity was 80.45%,specificity was 89.52%.Conclusion:The independent risk factors of bile duct injury in patients with acute cholecystitis after LC include the anatomy of the gallbladder triangle, the thickness of the gallbladder wall(>4 mm),intraoperative adhesion, the length of t

关 键 词：胆囊炎 急性 胆囊切除术 腹腔镜 胆管损伤 影响因素 

分 类 号：R657.4[医药卫生—外科学]