LCBDE术中一期缝合与T管引流的术后胆漏发生率比较  

Comparison of the incidence of postoperative bile leakage between primary closure and T-tube drainage in LCBDE

作　　者：陈哲[1] 吕昊阳 黄侠鸣 张启瑜[1] 俞富祥[1] CHEN Zhe;LYU Haoyang;HUANG Xiaming;ZHANG Qiyu;YU Fuxiang(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)

机构地区：[1]温州医科大学附属第一医院肝胆胰外科,浙江温州325000

出　　处：《肝胆胰外科杂志》2024年第4期211-217,共7页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的比较腹腔镜胆总管探查术中(LCBDE)行一期缝合和T管引流的术后胆漏发生率,并分析术后胆漏的危险因素。方法回顾性分析2015年1月至2022年11月于温州医科大学附属第一医院行LCBDE的患者资料,分为一期缝合组和T管引流组,采用Logistic多因素回归分别分析两组发生胆漏的危险因素。对两组中有肝内结石、上段胆总管结石、最大结石直径、体温最高值和中性粒细胞百分比5项指标进行倾向性评分匹配(PSM)后,比较两组胆漏发生率。结果共纳入患者1052例,其中143例患者发生术后胆漏,发生率为13.5%。Logistic多因素回归分析显示年龄>60岁为一期缝合组(n=506)胆漏的危险因素(OR=2.242,95%CI 1.300-4.038,P=0.005),主刀医师实施LCBDE少于10例为T管引流组(n=546)胆漏的危险因素(OR=3.525,95%CI 1.469-7.996,P=0.003)。经PSM成功匹配383对患者,一期缝合组胆漏发生率较T管引流组高[15.1%(58/383)vs 9.9%(38/383),P=0.029]。结论患者年龄>60岁是行LCBDE术中一期缝合后发生胆漏的独立危险因素,医师经验不足(主刀医师实施LCBDE少于10例)是行留置T管后发生胆漏的独立危险因素。相较于一期缝合,留置T管引流可以降低LCBDE术后胆漏的发生率。Objective To compare the incidence of postoperative bile leakage between primary duct closure and T-tube drainage in laparoscopic common bile duct exploration(LCBDE)and investigate the risk factors of postoperative bile leakage.Methods Clinical data of patients who underwent LCBDE in the First Affiliated Hospital of Wenzhou Medical University from Jan.2015 to Nov.2022 were retrospectively analyzed.Patients were divided into the primary closure group and the T-tube drainage group.The risk factors of postoperative bile leakage were analyzed by multivariate Logistic regression in the two groups respectively.The incidence of postoperative bile leakage in the two groups was compared by a propensity score matching(PSM)of 5 indicators,including intrahepatic stones,upper common bile duct stones,maximum stone diameter,highest body temperature,and neutrophil percentage-to-albumin ratio.Results A total of 1052 patients were included,and 143(13.5%)patients had postoperative bile leakage.Multivariate Logistic regression analysis showed that age>60 years(OR=2.242,95%CI 1.300-4.038,P=0.005)was a risk factor for bile leakage in the primary suture group(n=506),and the chief surgeon performed less than 10 cases of LCBDE(OR=3.525,95%CI 1.469-7.996,P=0.003)was a risk factor for postoperative bile leakage in the T-tube drainage group(n=546).Three hundred eighty-three pairs of patients were successfully matched after a propensity score matching.The incidence of postoperative bile leakage in the primary suture group was higher than that in the T-tube drainage group[15.1%(58/383)vs 9.9%(38/383),P=0.029].Conclusion Age>60 years is an independent risk factor for bile leakage after primary suture and surgeon’s inexperience(the chief surgeon performed less than 10 cases of LCBDE)is an independent risk factor for bile leakage after T-tube drainage.Compared with primary suture,T-tube drainage can reduce the incidence of bile leakage after LCBDE.

关 键 词：胆总管结石 胆总管探查术 一期缝合 T管引流 胆漏 倾向性评分匹配 

分 类 号：R657.4[医药卫生—外科学]