胆总管微创手术取石后两种引流方式发生胆漏的危险因素及其预测模型建立  

Risk factors of bile leakage after minimally invasive choledocholithotomy by two drainage methods and its establishment of prediction model

作　　者：马金玉 吕超 肖晶晶 刘徐洋 何楠 谷化剑 MA Jinyu;LYU Chao;XIAO Jingjing;LIU Xuyang;HE Nan;GU Huajian(College of Clinical Medicine,Guizhou Medical University,Guiyang 550002,Guizhou,China;Department of Pediatric Surgery,the Affiliated Hospital of Guizhou Medical University,Guiyang 550002,Guizhou,China)

机构地区：[1]贵州医科大学临床医学院,贵州贵阳550002 [2]贵州医科大学附属医院小儿外科,贵州贵阳550002 [3]贵州医科大学

出　　处：《贵州医科大学学报》2023年第1期70-76,共7页Journal of Guizhou Medical University

基　　金：贵州省科技计划项目(黔科合支撑2019-2793)。

摘　　要：目的分析腹腔镜下胆囊切除术+胆总管切开取石一期缝合术与T管引流术术后发生胆漏的危险因素,并建立术后发生胆漏预测模型。方法将273例胆囊结石合并胆总管结石患者根据手术方式分为一期缝合组和T管引流组,采用倾向得分匹配法(PSM)均衡组间混杂因素的影响后,比较两组患者一般资料、围手术期指标以及术后并发症等情况;回归分析术后胆漏的危险因素,并建立相关预测模型,使用ROC曲线下面积评价模型的预测效果。结果经PSM处理后,两组患者各保留59例,基线资料组间分布均衡;与T管引流组相比,一期缝合组的术后进食时间、拔除腹腔引流管时间,术后早期下床活动时间,手术时间和住院时间均明显缩短,且术中出血量及术后止痛药物用药次数也减少(P<0.05);两组患者术后并发症比较,差异无统计学意义(P>0.05);多因素logistic回归分析显示,胆总管直径<1 cm、术前营养得分≥2分、主刀手术者独立操作例数<30例是术后胆漏的独立危险因素(P<0.05);术后胆漏预测模型联合预测因子AUC值为0.785、95%CI为0.689~0.882,预测效果较好。结论胆总管结石腹腔镜下胆囊切除术一期缝合患者恢复较快,胆总管直径<1 cm、术前营养得分≥2分、主刀手术者独立操作例数<30例是术后胆漏的独立危险因素,胆漏预测模型可为临床提供一定的参考。Objective To analyze the clinical efficacy and safety of laparoscopic cholecystectomy+choledocholithotomy and one-stage suture and T-tube drainage,to explore the risk factors of postoperative bile leakage and to establish the predictive model.Methods Two hundred and seventy-three patients with cholecystolithiasis complicated with common bile duct stones were divided into one-stage suture group and T-tube drainage group according to different surgical methods.The patients’general data,perioperative indexes,postoperative complications etc.were detected,after various factors of influences were balanced using the propensity score matching(PSM)and the risk factors of postoperative bile leakage were detected by logistic regression analysis and the predictive model was established.And then the prediction effect of the model was evaluated by ROC curve.Results After PSM treatment,there existed 59 patients in each group,and the baseline data were evenly distributed among the groups.Compared with the T-tube drainage group,the one-stage suture group had postoperative feeding time,removal of abdominal drainage tube,and early postoperative ambulation.The time,operation time,and hospital stay were significantly shortened,and the intraoperative blood loss and the number of postoperative analgesic drugs in the one-stage suture group were also reduced(P<0.05).There was no statistical difference in postoperative complications between the two groups(P>0.05);multivariate logistic regression analysis showed that the diameter of the common bile duct<1 cm,the preoperative nutritional score≥2 points,and the number of independent operations performed by the main surgeon<30 cases were independent risk factors for postoperative bile leakage(P<0.05),and the AUC value of its prediction model combined with the predictive factor was 0.785,95%CI was 0.689-0.882,and the prediction effect was good.Conclusion The patients with cholecystolithiasis recover quickly after primary suture of cholecystectomy under the laparoscopy.The diameter of the c

关 键 词：胆囊结石 胆总管结石 腹腔镜 一期缝合术 T管引流术 胆漏 

分 类 号：R657.42[医药卫生—外科学]