LCBDE-LC术治疗老年胆总管结石伴胆囊结石围术期并发症的危险因素分析  

Analysis of risk factors for perioperative complications in the treatment of gallbladder stones with choledocholithiasis in the elderly with the LCBDE-LC procedure

作　　者：张修稳 汪欢[1] 林杰 胡飞 罗智 ZHANG Xiu-ven;WANG Huan;LIN Jie(Department of general surgery,Dongcheng Branch of the First Afiliated Hospital of Anhui Medical University,Hefei 231601,China)

机构地区：[1]安徽医科大学第一附属医院东城院区普外科,合肥231601

出　　处：《肝胆外科杂志》2024年第6期453-458,共6页Journal of Hepatobiliary Surgery

基　　金：安徽省高校自然科学研究项目(2023 AH053306);合肥市应用医学科研项目(Hwk2023zc014,Hwk2023zc016)。

摘　　要：目的分析LCBDE-LC治疗老年胆总管结石伴胆囊结石围手术期并发症及危险因素。方法采用回顾性病例对照研究,收集我院2021年6月至2024年6月期间接受LCBDE-LC手术的95例老年胆总管结石伴胆囊结石患者的临床资料,观察手术期间并发症的发生情况,并应用Clavien-Dindo分级进行评估,利用单因素及多因素Logistic回归分析,分析Ⅱ级及以上并发症的风险因素,并绘制受试者工作特征曲线进行评估。结果围手术期并发症的发生率为41例,约占43.16%,其中Clavien-Dindo分级显示Ⅰ级的患者为26.32%(25/95),Ⅱ级为13.68%(13/95),Ⅲa级为2.11%(2/95),而Ⅲb级则占1.05%(1/95)。多因素Logistic回归分析结果显示:Charlson合并症指数≥4(OR=4.532,95%CI=1.411-18.081,P=0.045)、ASA-PS≥Ⅲ(OR=4.302,95%CI=1.012-17.987,P=0.029)、合并中-重度急性胆管炎(OR=8.997,95%CI=2.391-38.012,P=0.005)是围手术期并发症的独立危险因素;三项风险因素及其合并预测概率的曲线下面积分别为0.766、0.728、0.848与0.894。结论Charlson合并症指数≥4、ASA-PS≥Ⅲ、合并中-重度急性胆管炎是老年胆总管结石合并胆囊结石患者行LCBDE-LC围术期并发症的独立危险因素,围手术期应充分评估,并重视三项危险因素的早期识别与早期干预。Objective Analysis of perioperative complications and risk factors of LC BDE-LC in the treatment of choledocholithiasis combined with gallbladder stones in elderly people.Methods A retrospective case-control study was used to collect the clinical data of 95 elderly patients with choledocholithiasis with gallbladder stones who underwent LCBDE-LC surgery in our hospital between June 2021 and June 2024,to observe the occurrence of complications during the surgery and to apply the Clavien-Dindo grading for assessment,and to utilize univariate and multivariate logistic regression analysis to The risk factors for grade II and above complications were analyzed and the working characteristic curves of the subjects were plotted for assessment.Results The incidence of perioperative complications was 41 cases,or about 43.16%,with Clavien-Dindo grading showing 26.32%(25/95)patients in grade I,13.68%(13/95)in gradeⅡ,2.11%(2/95)in gradeⅢa,and 1.05%(1/95)in gradeⅢb.The results of multifactorial logistic regression analysis showed that Charlson comorbidity index≥4(OR=4.532,95%CI=1.411-18.081,P=0.045),ASA-PS≥Ⅲ(OR=4.302,95%CI=1.012-17.987,P=0.029),and comorbidity with moderate-to-severe acute cholangitis(OR=8.997,95%CI=2.391-38.012,P=0.005)were independent risk factors for perioperative complications;the areas under the curves of the three risk factors and their combined predictive probabilities were 0.766,0.728,0.848,and 0.894,respectively.Conclusion Charlson comorbidity index≥4,ASA-PS≥Ⅲ,and combined moderate-to-severe acute cholangitis are independent risk factors for perioperative complications in elderly patients with choledochal stones combined with gallbladder stones who undergo LCBDE-LC,which should be adequately evaluated in the perioperative period,and emphasis should be placed on the early identification of the three risk factors and early intervention.

关 键 词：胆总管结石 胆囊结石 胆总管探查术、胆囊切除术 腹腔镜检查 老年人 围手术期并发症 危险因素 

分 类 号：R657.4[医药卫生—外科学]