复杂胆囊结石患者行LRC治疗的效果及影响因素分析  

Analysis of the Effects and Influencing Factors of LRC Treatment in Pa⁃tients with Complex Gallbladder Stones

作　　者：李刚 石勇健 李发贵 LI Gang;SHI Yongjian;LI Fagui(Department of General Surgery,Baiyun District People's Hospital,Guiyang,Guizhou Province,550014 China)

机构地区：[1]贵阳市白云区人民医院普外科,贵州贵阳550014

出　　处：《中外医疗》2024年第13期9-12,共4页China & Foreign Medical Treatment

摘　　要：目的调查复杂胆囊结石患者采用腹腔镜逆行胆囊切除术(Laparoscopic Retrograde Cholecystectomy,LRC)进行治疗的临床疗效,分析其影响因素。方法回顾性选取2021年1月—2022年7月贵阳市白云区人民医院收治的100例复杂性胆囊结石患者的临床资料。根据疗效评价结果,将其分为疗效欠佳组(n=21)和疗效良好组(n=79),比较两组基线资料、手术治疗记录等相关信息,采用单因素和Logistic多因素分析方法分析疗效欠佳的影响因素。结果100例患者中,21例患者的疗效欠佳,发生率为21.00%。两组是否合并糖尿病、胆囊壁厚度、周围脏器粘连、高密度脂蛋白胆固醇水平、手术性质、服用中药或中成药对比,差异有统计学意义(P均<0.05)。Logistic回归分析发现,合并糖尿病(OR=5.388,95%CI=1.364~21.274)、胆囊壁厚度>5 mm(OR=3.910,95%CI=1.021~14.974)、周围脏器粘连(OR=5.620,95%CI=1.078~29.312)、高密度脂蛋白胆固醇水平<1.04 mmol/L(OR=3.722,95%CI=1.050~13.197)是复杂性胆囊结石患者LRC疗效欠佳的独立危险因素,而术后服用中药或中成药(OR=0.228,95%CI=0.058~0.895)是其独立保护因素。结论LRC手术的治疗效果可受到糖尿病、周围脏器粘连、胆囊壁厚度>5 mm等因素的影响,早期识别高危人群,加强术后不良事件的监测,具有重要意义。Objective To investigate the clinical efficacy of treatment with laparoscopic retrograde cholecystectomy(LRC)in patients with complex gallbladder stones,and to analyze its influencing factors.Methods The clinical data of 100 cases of complex gallbladder stones admitted to Baiyun District People's Hospital from January 2021 to July 2022 were retrospectively selected.According to the results of efficacy evaluation,the patients were divided into poor efficacy group(n=21)and good efficacy group(n=79),and the baseline data,surgical treatment records and other relevant information of the two groups were compared,and the influencing factors of poor efficacy were analyzed using univariate analysis and Logistic multivariate analysis.Results Among 100 patients,21 patients had poor efficacy,with a total incidence of 21.00%.The differences between the two groups in terms of diabetes,gallbladder wall thickness,adhesions to surrounding organs,high density lipoprotein cholesterol,nature of surgery,and administration of traditional Chinese medicine or proprietary Chinese medicine were statistically significant(all P<0.05).Logistic regression analysis found that combined diabetes mellitus(OR=5.388,95%CI=1.364~21.274),gallbladder wall thickness>5 mm(OR=3.910,95%CI=1.021~14.974),peripheral organ adhesion(OR=5.620,95%CI=1.078~29.312)and the level of high-density lipoprotein cholesterol<1.04 mmol/L(OR=3.722,95%CI=1.050~13.197)were the risk factors for poor LRC outcome in patients with complicated gallbladder stones.And postoperative administration of traditional Chinese medicine or proprietary Chinese medicine(OR=0.228,95%CI=0.058~0.895)was a protective factor.Conclusion The therapeutic efficacy of LRC surgery can be affected by factors such as diabetes mellitus,adhesion of peripheral organs,and gallbladder wall thickness>5 mm,and early identification of high-risk groups and strengthening the monitoring of postoperative adverse events are of great significance.

关 键 词：复杂性胆囊结石 腹腔镜逆行胆囊切除术 临床疗效 影响因素 

分 类 号：R657.42[医药卫生—外科学]