胃切除术后再发胆道结石患者发生胆源性胰腺炎的影响因素分析  

Analysis of influencing factors of biliary pancreatitis in patients withrecurrent biliary calculi after gastrectomy

作　　者：林庆斌 王健[1] 庄佳毅 陈玲[2] LIN Qingbin;WANG Jian;ZHUANG Jiayi;CHEN Ling(Emergency Department,The 909th Hospital,Dongnan Hospital of Xiamen University,Zhangzhou 363000,Fujian,China;Gastroenterology Department,The 909th Hospital,Dongnan Hospital of Xiamen University,Zhangzhou 363000,Fujian,China)

机构地区：[1]第九〇九医院·厦门大学附属东南医院急诊医学科,福建漳州363000 [2]第九〇九医院·厦门大学附属东南医院消化内科,福建漳州363000

出　　处：《西部医学》2024年第7期1003-1006,共4页Medical Journal of West China

基　　金：2018年度军队后勤科研重大项目(BLB18J006)。

摘　　要：目的探讨胃切除术后合并胆道结石患者发生胆源性胰腺炎的影响因素,并分析再次腹腔镜手术失败的原因。方法回顾性分析2019年1月—2021年12月第九〇九医院收治的胃切除术后再发胆道结石患者69例,其中合并胆源性胰腺炎31例(观察组)、无合并胆源性胰腺炎38例(对照组)。69例患者中腹腔镜手术47例、中转开腹22例,单因素和Logistic多因素分别分析胆源性胰腺炎和腹腔镜手术的影响因素。结果单因素分析发现,胃切除范围、病理性质、淋巴结清扫、重建方式、结石个数、结石大小与胆源性胰腺炎发生相关(P<0.05),既往手术方式、淋巴结清扫、重建方式、结石大小、手术部位是腹腔镜手术中转开腹影响因素(P<0.05);多因素分析发现,全胃切除、病理性质恶性、多发结石、结石直径<5 mm是胆源性胰腺炎发生的独立影响因素(P<0.05),既往开腹手术、非生理性消化道重建、胆道手术是腹腔镜中转开腹的独立影响因素(P<0.05)。结论对于胃切除术后再发胆道结石患者,要尽早治疗避免胆源性胰腺炎的发生,同时也要根据患者个体化情况制定适合的治疗方式。Objective To investigate the influential factors of biliary pancreatitis in patients with biliary calculi after gastrectomy,and analyze the causes of failure of laparoscopic surgery again.Methods A retrospective analysis was performed on 69 patients with recurrent cholangiolithiasis after gastrectomy in the 909th Hospital from 2019 to 2021.Patients with biliary pancreatitis were the observation group,and 38 patients without biliary pancreatitis were the control group.Among the 69 patients,laparoscopic surgery was successful in 47 cases and failed in 22 cases.Univariate and Logistic factors were used to analyze the influencing factors of biliary pancreatitis and laparoscopic pancreatitis.Results Univariate analysis showed that gastrectomy scope,pathological nature,lymph node dissection,reconstruction method,number of stones and stone size were correlated with the occurrence of biliary pancreatitis(P<0.05),previous surgical method,lymph node dissection,reconstruction method,stone size and surgical site were the influencing factors of laparoscopic surgery failure(P<0.05).Multivariate analysis showed that total gastrectomy,pathological malignancy,multiple calculi,and calculi diameter<5 mm were independent factors for the occurrence of biliary pancreatitis(P<0.05),while previous laparotomy,non-physiological digestive tract reconstruction,and biliary tract surgery were independent factors for the failure of laparoscopic surgery(P<0.05).Conclusion For patients with recurrent biliary stones after gastrectomy,it is necessary to treat them as soon as possible to avoid the occurrence of biliary pancreatitis,and at the same time,appropriate treatment should be developed according to the individual situation of patients.

关 键 词：胃切除术 胆囊结石 胆道结石 胆源性胰腺炎 腹腔镜手术 

分 类 号：R656.61[医药卫生—外科学] R575.62[医药卫生—临床医学]