基于倾向性评分匹配比较急诊与择期腹腔镜胆总管探查术在胆总管结石合并急性胆管炎中的疗效  

Comparison of Emergency and Elective Laparoscopic Common Bile Duct Exploration in the Treatment of Choledocholithiasis with Acute Cholangitis Based on Propensity Score Matching

作　　者：鲁为朋 徐庆春 刘志刚[2] LU Weipeng;XU Qingchun;LIU Zhigang(Wuhu Hospital,East China Normal University,Anhui 241000,China)

机构地区：[1]华东师范大学附属芜湖医院急诊外科,241000 [2]华东师范大学附属芜湖医院肝胆外科,241000

出　　处：《医学研究杂志》2024年第11期100-104,共5页Journal of Medical Research

基　　金：安徽省医疗卫生重点专科建设项目{皖卫教科发[2021]1号};安徽省芜湖市卫生健康委员会项目(WHWJ2021y021);华东师范大学附属芜湖医院临床科研项目(LC2022A04)。

摘　　要：目的 基于倾向评分匹配(propensity score matching, PSM)比较急诊与择期腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration, LCBDE)治疗胆总管结石合并急性胆管炎的临床疗效。方法 采用回顾性队列研究方法,收集2021年1月~2023年10月华东师范大学附属芜湖医院收治的行LCBDE治疗的162例胆总管结石合并急性胆管炎患者的临床资料,其中急诊行LCBDE患者59例(急诊组),保守治疗后择期行LCBDE患者103例(择期组)。以PSM法对两组患者经1∶1匹配,比较两组相关临床资料。结果 两组成功匹配44对患者,急诊组术中出血量多于择期组(65.00±19.88ml vs 54.89±17.90ml,P=0.014);抗菌药物使用时间低于择期组(3.68±1.46天vs 5.95±1.46天,P<0.001);住院总时间低于择期组[7.0(6.0,8.0)天vs 8.0(7.0,9.0)天,P<0.001];住院总费用低于择期组[1.19(1.10,1.45)万元vs 1.43(1.22,1.67)万元,P=0.001]。两组手术时间、中转开腹率、手术方式比例、腹腔引流管拔除时间、术后住院时间、术后并发症发生率比较,差异均无统计学意义(P>0.05)。结论 急诊与择期LCBDE治疗胆总管结石合并轻、中度急性胆管炎均是安全、有效的,但急诊LCBDE在抗菌药物使用时间、住院总时间和住院总费用方面具有显著优势。Objective To compare the clinical efficacy of emergency and elective laparoscopic common bile duct exploration(LCBDE)in the treatment of choledocholithiasis with acute cholangitis based on propensity score matching(PSM).Methods Retrospective cohort study was used.The clinical data of 162 patients with choledocholithiasis complicated with acute cholangitis who underwent LCBDE in Wuhu Hospital,East China Normal University from January 2021 to October 2023 were retrospectively analyzed.Among them,59 patients underwent emergency LCBDE(emergency group),and 103 patients underwent elective LCBDE after conservative treatment(elective group).The PSM method was used to match the two groups of patients by 1∶1,and the relevant clinical data of the two groups were compared.Results The two groups successfully matched 44 pairs of patients.The intraoperative blood loss in the emergency group was more than that in the elective group(65.00±19.88ml vs 54.89±17.90ml,P=0.014).The use time of antibiotics was lower than that in the elective group(3.68±1.46days vs 5.95±1.46days,P<0.001).The total hospitalization time was lower than that in the elective group[7.0(6.0,8.0)days vs 8.0(7.0,9.0)days,P<0.001].The hospitalization cost was lower than that in the elective group[1.19(1.10,1.45)ten thousand yuan vs 1.43(1.22,1.67)ten thousand yuan,P=0.001].There was no significant difference in operation time,conversion rate,operation method,peritoneal drainage tube removal time,postoperative hospital stay,and postoperative complication rate between the two groups(P>0.05).Conclusion Both emergency and elective LCBDE are safe and effective in the treatment of choledocholithiasis with mild to moderate acute cholangitis,but emergency LCBDE has significant advantages in the use of antibiotics,total hospitalization time and hospitalization costs.

关 键 词：急诊 择期 腹腔镜胆总管探查术 胆总管结石 急性胆管炎 倾向评分匹配 

分 类 号：R657.4[医药卫生—外科学]