腹腔镜胆囊切除术后并发症的危险因素分析  

Analysis of risk factors of complications after laparoscopic cholecystectomy

作　　者：付靖楠 赵冬雨 张瑞奎 FU Jingnan;ZHAO Dongyu;ZHANG Ruikui(Department of Secret Service Emergency Surgery,Characteristic Medical Center of Chinese People's Armed Police Force,Tianjin 300162,China)

机构地区：[1]武警特色医学中心特勤急救外科,天津300162

出　　处：《中国当代医药》2023年第26期17-21,共5页China Modern Medicine

基　　金：武警部队参谋部软科学论证研究项目(后战函〔2022〕413号)。

摘　　要：目的分析腹腔镜胆囊切除术(LC)后并发症的危险因素。方法回顾性分析2018年3月至2022年9月武警特色医学中心及天津医科大学总医院478例行LC患者的临床资料,对其术后并发症及相关危险因素的发生进行分析。结果共有36例(7.53%)患者出现并发症,其中腹腔出血9例(1.88%),胆管损伤8例(1.67%),胆瘘19例(3.97%);单因素分析结果显示:LC术后并发症的发生与Calot三角粘连、解剖变异、胆囊壁厚度、急性生理和慢性健康评分(APACHE-Ⅱ)、美国麻醉医师协会(ASA)麻醉分级及谷丙转氨酶有关,差异有统计学意义(P<0.05)。多因素分析结果显示:Calot三角粘连(β=-1.084,OR=0.338,95%CI:0.153~0.748)、解剖变异(β=1.103,OR=3.014,95%CI:1.060~8.571)及胆囊壁增厚≥5 mm(β=-0.913,OR=0.401,95%CI:0.177~0.908)是LC后并发症的影响因素(P<0.05)。结论LC术前应掌握好患者的危险因素,做好术前准备,以减少术后并发症的发生。Objective To analyze the risk factors of complications after laparoscopic cholecystectomy(LC).Methods The clinical data of 478 patients who underwent LC in the Characteristic Medical Center of Chinese People's Armed Police Force and Tianjin Medical University General Hospital from March 2018 to September 2022 were retrospectively analyzed,and the occurrence of postoperative complications and related risk factors were analyzed.Results A total of 36 patients(7.53%)had complications,including 9 cases of abdominal hemorrhage(1.88%),8 cases of bile duct injury(1.67%),and 19 cases of biliary fistula(3.97%).The results of univariate analysis showed that the incidence of postoperative complications after LC was related to Calot triangle adhesion,anatomical variation,gallbladder wall thickness,acute physiology and chronic health evaluation(APACHE-Ⅱ),American Society of Anesthesiologists(ASA)classification and alanine aminotransferase,and the differences were statistically significant(P<0.05).Multivariate analysis showed that Calot triangle adhesion(β=-1.084,OR=0.338,95%CI:0.153-0.748),anatomical variation(β=1.103,OR=3.014,95%CI:1.060-8.571)and gallbladder wall thickening≥5 mm(β=-0.913,OR=0.401,95%CI:0.177-0.908)were influencing factors for complications after LC(P<0.05).Conclusion In order to reduce the occurrence of postoperative complications,it is necessary to master the risk factors of patients and make preoperative preparations before LC.

关 键 词：腹腔镜胆囊切除术 并发症 危险因素 CALOT三角 

分 类 号：R657.4[医药卫生—外科学]