LCBDE术后一期缝合治疗肝硬化合并胆管结石的疗效及其影响因素  

An analysis on the efficacy and prognostic impact factors of postoperative primary suture of laparoscopic common bile duct exploration for the treatment of liver cirrhosis complicated with bile duct stones

作　　者：刘爽 吴涯昆 刘袁君[1] 田银生[1] LIU Shuang;WU Ya-kun;LIU Yuan-jun;TIAN Yin-sheng(Suining Central Hospital,Sichuan 629000,China)

机构地区：[1]遂宁市中心医院肝胆外科,四川629000

出　　处：《肝脏》2023年第5期544-548,共5页Chinese Hepatology

基　　金：四川省卫生和计划生育委员会科研课题(17ZD020)。

摘　　要：目的探讨腹腔镜胆总管探查术(LCBDE)术后一期缝合治疗肝硬化合并胆管结石的疗效及其影响因素。方法回顾性分析2020年3月至2022年3月遂宁市中心医院肝胆外科收治并手术的肝硬化合并胆管结石的患者124例,按随机数字表法将所有患者分为对照组62例和研究组62例。两组均行LCBDE术,对照组术后进行T管引流,研究组术后一期缝合,观察两组患者围术期指标、术后并发症发生情况、术后24 h采用疼痛视觉模拟量表(VAS)评分,logistic回归分析术后效果不良的影响因素。结果两组术中出血量比较差异无统计学意义(P>0.05),研究组引流时间为(4.95±0.22)d,长于对照组的(4.42±0.26)d(P<0.05),手术时间和住院时间为(90.16±8.12)min和(5.19±1.16)d,短于对照组的(99.22±9.14)min和(7.62±1.26)d(P<0.05)。研究组患者术后并发症发生率为11.29%(7/62),对照组患者术后并发症发生率为9.68%(6/62),差异无统计学意义(P>0.05)。研究组术后VAS评分为(3.08±0.22)分,低于对照组的(4.26±0.21)分(P<0.05)。单因素分析结果显示,合并基础疾病、胆总管直径、主刀手术操作例数、T管引流均是LCBDE术后一期缝合效果不良的影响因素(P<0.05),而性别、年龄、ASA评分、中性粒细胞数、CRP和术前胆红素水平、胆管缝合方式、胆管结石数均不是LCBDE术后一期缝合效果不良的影响因素(P>0.05)。logistic回归分析结果显示,合并基础疾病、胆总管直径<1 cm、主刀手术操作少于28例、T管引流均是LCBDE术后一期缝合效果不良独立高危因素(P<0.05)。结论相比T管引流,LCBDE术后一期缝合具有手术时间短、术后疼痛轻、住院时间短等优点,且不会增加术后效果不良的发生。合并基础疾病、胆总管直径<1 cm、主刀手术操作少于28例、T管引流为LCBDE术后一期缝合效果不良的的独立高危因素。Objective To investigate the efficacy of primary suture after laparoscopic common bile duct exploration(LCBDE)in the treatment of liver cirrhosis complicated with bile duct stones and the impact factors on postoperative prognosis.Methods One hundred and twenty-four cases of liver cirrhosis complicated with bile duct stones who were operated in hepatobiliary surgery of Suining Central Hospital from March 2020 to March 2022 were analyzed retrospectively.According to the random number table method,all patients were divided into a control group(N=62 cases)and a study group(N=62 cases).LCBDE was performed in both groups.Patients in the control group were treated with T-tube drainage,and patients in the study group were primary sutured after operation.The perioperative indexes and postoperative complications of these two groups were observed.Pain visual analogue scale(VAS)score were obtained at 24 hours after operation.The influencing factors for postoperative prognosis were analyzed by logistic regression.Results When compared the patients in the control group with those in the study group,the intraoperative bleeding volumes were not statistically significant(P>0.05).The drainage times for patients in the study group(4.95±0.22 d)were longer than those of the control group(4.42±0.26 d)(P<0.05).The opertation times(90.16±8.12 min)and hospital stays(5.19±1.16 d)of patients in the study group were shorter than those of 99.2±9.14 min and 7.62±1.26 d,respectively,in the control group(P<0.05);The incidence of postoperative complications was 11.29%in the study group,which had no significant difference than that of 9.68%in the control group(P>0.05);The VAS score of the study group was lower than that of the control group(P<0.05).By univariate analysis it was showed that complicated with basic diseases,diameter of common bile duct,total number of cases operated by the chief surgeon,and T-tube drainage were the influencing factors for a poorer effect of primary suture after LCBDE(P<0.05),while gender,age,ASA score,neutroph

关 键 词：腹腔镜胆总管探查术 肝硬化 胆管结石 疗效 影响因素 

分 类 号：R657.3[医药卫生—外科学] R657.4[医药卫生—临床医学]