创伤性肝破裂患者术后胆漏发生的影响因素及其预测模型构建  

Risk factors for the incidence of postoperative bile leakage after traumatic liver rupture and construction of a predictive model

作　　者：王缵禹 邓翔 何钰楠 聂山茂 张杨[1] Wang Zuanyu;Deng Xiang;He Yunan;Nie Shanmao;Zhang Yang(Hepatobiliary Pancreatic and Splenic Surgery Department,Luzhou People's Hospital,Luzhou,Sichuan 646000,China;Department of Emergency,Luzhou People's Hospital,Luzhou,Sichuan 646000,China)

机构地区：[1]泸州市人民医院肝胆胰脾外科,四川泸州646000 [2]泸州市人民医院急诊医学部,四川泸州646000

出　　处：《创伤外科杂志》2023年第9期681-686,共6页Journal of Traumatic Surgery

摘　　要：目的探讨创伤性肝破裂术后患者胆漏发生的影响因素,并构建相关预测模型。方法回顾性分析2016年1月—2020年12月四川省泸州市人民医院收治的52例创伤性肝破裂术患者临床资料,按照患者术后是否发生胆漏分为胆漏组(n=18)与非胆漏组(n=34),收集入选病例资料(包括年龄、性别、白蛋白水平、总胆红素、手术时间、手术方式、胆肠吻合术式、是否初次发生肝破裂、术中出血量、术者操作经验、合并胆管炎、合并胆囊结石、损伤分级、合并糖尿病、合并高血脂症),并应用二元Logistic回归分析创伤性肝破裂术后患者发生胆漏的影响因素。结果52例患者中男性33例,女性19例;年龄22~65岁,平均44.6岁;致伤原因:道路交通伤25例,高处坠落伤13例,撞击伤9例,其他伤5例。创伤性肝破裂患者术后发生胆漏18例(34.6%),其中肝实质胆漏11例(61.1%),胆总管胆漏5例(27.8%),T管窦道漏2例(11.1%)。单因素分析显示手术方式、胆肠吻合术式、是否初次发生肝破裂、术者操作经验、合并胆管炎、合并胆囊结石、合并糖尿病均是创伤性肝破裂患者术后发生胆漏的危险因素(P<0.05);Logistic回归分析表示手术方式(OR=2.678,95%CI=1.174~6.110)、胆肠吻合术式(OR=2.086,95%CI=1.079~4.031)、是否初次发生肝破裂(OR=2.776,95%CI=1.517~5.078)、术者操作经验(OR=2.349,95%CI=1.276~4.323)、合并胆管炎(OR=2.779,95%CI=1.230~6.278)、合并胆囊结石(OR=1.846,95%CI=1.468~2.321)、合并糖尿病(OR=2.186,95%CI=1.336~3.575)均是创伤性肝破裂患者术后发生胆漏的独立危险因素(P<0.05)。基于上述因素建立创伤性肝破裂术后胆漏发生的列线图风险预测模型。模型验证结果显示,该列线图模型的一致性指数为0.784(95%CI:0.632~0.891)。结论手术方式、胆肠吻合术式、是否初次发生肝破裂、术者操作经验、合并胆管炎、合并胆囊结石以及合并糖尿病会增加创伤性肝破裂患者手�Objective To investigate the factors influencing the occurrence of postoperative bile leakage in patients with traumatic liver rupture and to construct a relevant prediction model.Methods Clinical data of 52 patients with traumatic liver rupture who underwent repair surgery in our hospital from Jan.2016 to Dec.2020 were retrospectively analyzed.According to whether bile leakage occurred,patients were divided into leakage group(n=18)and non-leakage group(n=34).Parameters of age,sex,albumin levels,total bilirubin,operation time,operation method,biliary-intestinal anastomosis procedures,whether first onset of hepatic rupture,intraoperative blood loss,operative experience of the surgeons,combination of cholangitis or gallstones,injury severity,and comorbidity of diabetes or hyperlipidemia were collected and analyzed for their influence on postoperative bile leakage by binary logistic regression.Results Among the 52 patients,33 were male and 19 were female;age ranged from 22 to 65 years,mean 44.6 years;injury causes were road traffic accidents in 25 cases,falls in 13,impact in 9,and others in 5.Among them,18(34.6%)developed bile leakage after surgery,11(21.2%)from the liver parenchyma,5(9.6%)from the common bile duct,and 2(3.9%)from the T tube sinus tract.Univariate analysis showed that surgical method,biliary-intestinal anastomosis procedure,whether the first onset of hepatic rupture,experience of the surgeons,combination of cholangitis,combination of gallstone and diabetes comorbidity were risk factors for postoperative bile leakage in patients with traumatic liver rupture(P<0.05).Logistic regression analysis further indicated that the surgical methods(OR=2.678,95%CI=1.174-6.110),bile-intestinal anastomosis procedures(OR=2.086,95%CI=1.079-4.031),whether the first onset of hepatic rupture(OR=2.776,95%CI=1.517-5.078),operative experience of the surgeons(OR=2.349,95%CI=1.276-4.323),combined cholangitis(OR=2.779,95%CI=1.230-6.278),combined gallstones(OR=1.846,95%CI=1.468-2.321),and comorbid diabetes(OR=2.186,95%CI=1.336

关 键 词：创伤性肝破裂 胆漏 影响因素 发生现状 

分 类 号：R657.32[医药卫生—外科学]