胆道镜取石日归手术延迟出院的危险因素分析  

Analysis of risk factors for delayed discharge following same-day choledochoscopic lithotomy

作　　者：雷甜甜[1] 刘洋[1] 宋应寒[1] 梁鹏[1,2] LEI Tiantian;LIU Yang;SONG Yinghan;LIANG Peng(Day Surgery Center,General Practice Medical Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Anesthesia Surgery Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院全科医学中心日间手术中心,成都610041 [2]四川大学华西医院麻醉手术中心,成都610041

出　　处：《华西医学》2025年第2期229-234,共6页West China Medical Journal

基　　金：四川省科技计划项目(2022JDR0193,2022YFS0230)。

摘　　要：目的探讨经胆道镜取石日归手术治疗胆道术后残余结石延迟出院的危险因素。方法回顾性收集2019年7月—2022年7月在四川大学华西医院日间手术中心收治的607例次胆道术后残余结石患者临床资料,根据患者是否当日出院分为日归手术组和延迟出院组。比较并分析性别、年龄、首次外科手术情况(外科手术方式、是否行肝脏切除、是否行术中胆道镜)、胆道镜取石情况(是否为首次胆道镜治疗、取石方式、结石数目、结石部位)、手术时长、住院时长、住院费用、术后并发症(发热、引流不畅、T管脱落)在两组间的差异,运用多因素logistic回归模型分析胆道镜取石日归手术延迟出院的危险因素。结果患者均于24 h内完成入、出院,其中当日出院557例次(91.8%),次日出院50例次(8.2%)。多因素logistic回归分析结果显示,首次胆道镜治疗[比值比(odds ratio,OR)=2.359,95%置信区间(confidence interval,CI)(1.303,4.273),P=0.005]、液电碎石后取石[OR=1.857,95%CI(1.013,3.402),P=0.045]、多发结石(结石数目≥2个)[OR=2.741,95%CI(1.194,6.288),P=0.017]是延迟出院的独立危险因素。结论胆道镜取石日归手术开展成熟,首次胆道镜治疗、液电碎石后取石、多发结石(结石数目≥2个)是延迟出院的独立危险因素。Objective To investigate the risk factors for delayed discharge following same-day choledochoscopic lithotomy for residual stones after biliary tract surgery.Methods The clinical data of 607 patients with residual stone after biliary tract surgery admitted to the Day Surgery Center of West China Hospital of Sichuan University between July 2019 and July 2022 were retrospectively collected.According to whether the patients were discharged on the same day,they were divided into same-day discharge group and delayed discharge group.The differences in gender,age,first surgical procedure(surgical method,hepatectomy or not,intraoperative choledochoscopy or not),choledochoscopic lithotomy(first choledochoscopy or not,lithotomy method,number of stones and site of stones),operation duration,hospital stay,hospital cost,and postoperative complications(fever,poor drainage,and T tube dislodgement)between the two groups were compared and analyzed.Multiple logistic regression model was used to analyze the risk factors for delayed discharge following same-day choledochoscopic lithotomy.Results All patients were admitted and discharged within 24 h,among them,557 cases(91.8%)were discharged on the same day and 50 cases(8.2%)were discharged the next day.The results of multiple logistic regression analysis showed that choledochoscopy for the first time[odds ratio(OR)=2.359,95%confidence interval(CI)(1.303,4.273),P=0.005],lithotomy after electrohydraulic lithotripsy[OR=1.857,95%CI(1.013,3.402),P=0.045],and multiple stones(number of stones≥2)[OR=2.741,95%CI(1.194,6.288),P=0.017]were independent risk factors for delayed discharge.Conclusion The operation of same-day choledochoscopic lithotomy is mature,and choledochoscopy for the first time,lithotomy after electrohydraulic lithotripsy,and multiple stones(number of stones≥2)are independent risk factors for delayed discharge.

关 键 词：胆道镜检查 肝胆管结石 日归手术 危险因素 

分 类 号：R657.4[医药卫生—外科学]