倾向性匹配分析序贯治疗与急诊手术治疗成人胆总管结石伴急性胆管炎临床疗效  

Propensity matching analysis of clinical efficacy of sequential therapy and emergency surgery for adult choledocholithiasis complicated by acute cholangitis

作　　者：杜智 何湛[1] 倪德生[1] Du Zhi;He Zhan;Ni Desheng(Hepatobiliary Surgery Department of Jinhua People's Hospital,Jinhua 321000,China)

机构地区：[1]金华市人民医院肝胆外科,浙江金华321000

出　　处：《中国急救医学》2024年第9期791-795,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨倾向性匹配分析序贯治疗与急诊手术治疗成人胆总管结石伴急性胆管炎临床疗效。方法收集2019年9月至2023年7月金华市人民医院收治的成人胆总管结石伴急性胆管炎患者90例临床资料,根据纳排标准最终纳入具有完整随访资料的患者88例,其中接受序贯治疗为序贯组(n=47),接受急诊手术治疗为对照组(n=41),倾向性匹配分析,以1∶1比例匹配两组临床资料,按照匹配分析后的资料进一步分析两组围术期指标、并发症情况、结石清除率、血清总胆红素和谷丙转氨酶(ALT)水平。结果序贯组手术时间(min:95.12±14.51 vs.73.15±12.17)较对照组长,但腹腔引流管拔除时间(d:10.01±2.32 vs.13.34±2.15)、胆道引流管拔除时间(d:25.41±5.06 vs.28.79±6.15)、肛门排气时间(h:21.51±4.21 vs.25.29±3.19)、住院时间(d:12.21±3.38 vs.14.56±3.16)均短于对照组(P均<0.05),序贯组术中出血量(mL:26.14±8.05 vs.35.21±10.75)少于对照组(P<0.05);序贯组结石清除率88.89%(32/36)高于对照组结石清除率69.44%(25/36)(χ^(2)=4.126,P=0.042)。治疗后两组血清总胆红素和ALT水平均较入院时明显下降(P<0.05),序贯组血清总胆红素(μmol/L:32.33±5.95 vs.55.89±7.41)和ALT水平(U/L:45.76±7.16 vs.53.48±9.21)均低于对照组(P<0.05)。结论在成人胆总管结石伴急性胆管炎治疗中,序贯治疗结石清除率高,住院时间短,且术中出血量较少。Objective To analyze the clinical efficacy of sequential therapy and emergency surgery in the treatment of adult choledocholithiasis complicated by acute cholangitis by using propensity matching analysis.Methods Clinical data of 90 adult patients with choledocholithiasis complicated by acute cholangitis admitted to Jinhua People's Hospital from September 2019 to July 2023 were collected.A total of 88 patients with complete follow-up data were finally included according to the inclusion and exclusion criteria,including 47 patients receiving sequential therapy(sequential group)and 41 patients receiving emergency surgical treatment(control group).Clinical data of the two groups were matched with 1∶1 ratio,and perioperative indexes,complications,stone clearance,serum total bilirubin and alanine transaminase(ALT)levels of the two groups were further analyzed according to the matched data.Results The operative time of the sequential group was longer than that of the control group(min:95.12±14.51 vs.73.15±12.17),the abdominal drainage tube removal time(d:10.01±2.32 vs.13.34±2.15),biliary drainage tube removal time(d:25.41±5.06 vs.28.79±6.15),anal exhaust time(h:21.51±4.21 vs.25.29±3.19)and hospital stay time(d:12.21±3.38 vs.14.56±3.16)of the sequential group were shorter than those of the control group(P<0.05),and the intraoperative blood loss of the sequential group was less than that of the control group(mL:26.14±8.05 vs.35.21±10.75,P<0.05).The stone clearance rate of the sequential group was higher than that of the control group[88.89%(32/36)vs.69.44%(25/36),χ^(2)=4.126,P=0.042].The serum total bilirubin and ALT levels of the two groups were significantly decreased after the treatment compared with those at admission(P<0.05),and the serum total bilirubin(μmol/L:32.33±5.95 vs.55.89±7.41)and ALT levels(U/L:45.76±7.16 vs.53.48±9.21)of the sequential group were lower than those of the control group(P<0.05).Conclusions In the treatment of adult choledocholithiasis complicated by acute cholangitis,seque

关 键 词：胆总管结石 急性胆管炎 倾向性匹配分析 序贯治疗 急诊手术 

分 类 号：R657.4[医药卫生—外科学]