肝外伤破裂患者治疗后胆漏发生影响因素分析  

Analysis of influencing factors of bile leakage after treatment in patients with liver trauma and rupture

作　　者：陈宗杰 胡添松[1] Chen Zongjie;Hu Tiansong(Department of Interventional Medicine,The 909th Hospital(Southeast Hospital Affiliated to Xiamen University),Zhangzhou 363000,China)

机构地区：[1]第九〇九医院(厦门大学附属东南医院)介入科,福建省漳州市363000

出　　处：《中华肝脏外科手术学电子杂志》2024年第6期836-840,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨肝外伤破裂患者治疗后胆漏发生影响因素。方法回顾性分析2006年1月至2019年12月第九〇九医院收治的357例肝外伤破裂患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男227例,女130例;年龄21~64岁,中位年龄44岁。美国创伤外科协会(AAST)肝外伤分级Ⅰ级125例,Ⅱ~Ⅲ级201例,Ⅳ~Ⅴ级31例。肝外伤破裂后手术治疗177例,介入治疗122例,保守治疗58例。影响胆漏发生的多因素分析采用Logistic回归模型。结果肝外伤破裂后发生胆漏56例,胆漏发生率15.7%(56/357),其中国际肝脏外科研究小组(ISGLS)胆漏分级A级35例,B级21例。Logistic多因素分析显示,肝功能Child-Pugh分级B级和C级、非手术治疗、出血量≥400 ml、无T管引流、Ⅱ~Ⅴ级肝外伤是胆漏发生的独立危险因素(OR=4.121,3.575,12.923,72.168,5.501;P<0.05)。结论肝外伤破裂患者胆漏发生率较高,肝功能分级、治疗方式、出血量、T管引流、肝外伤分级均是胆漏发生的独立影响因素,应重视防范危险因素,采取合理手术治疗策略降低胆漏发生率。Objective To investigate the influencing factors of bile leakage in patients with liver trauma and rupture after treatment.Methods Clinical data of 357 patients with liver trauma and rupture admitted to the 909th Hospital from January 2006 to December 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,227 patients were male and 130 female,aged 21-64 years,with a median age of 44 years.According to American Association for the Surgery of Trauma(AAST)grading scale,125 cases were classified as gradeⅠ,201 cases as gradeⅡ-Ⅲ,and 31 cases as gradeⅣ-Ⅴ.177 cases received surgery,122 cases by interventional therapy and 58 cases by conservative treatment after liver trauma and rupture.Logistic regression model was used for multivariate analysis of bile leakage.Results Bile leakage occurred in 56 cases after liver trauma and rupture,and the incidence of bile leakage was 15.7%(56/357).Among them,35 cases were classified as grade A and 21 cases as grade B based on the International Study Group of Liver Surgery(ISGLS)classification.Multivariate Logistic analysis showed that Child-Pugh B and C,non-surgical treatment,bleeding volume≥400 ml,T-tube free drainage,and gradeⅡ-Ⅴliver trauma were the independent risk factors for bile leakage(OR=4.121,3.575,12.923,72.168,5.501;P<0.05).Conclusions The incidence of bile leakage is high in patients with liver trauma and rupture.Liver function classification,treatment method,blood loss,T-tube drainage and liver trauma classification are the independent influencing factors for bile leakage.Extensive attention should be paid to preventing risk factors.Effective surgical treatment strategies should be employed to reduce the incidence of bile leakage.

关 键 词：肝外伤 胆漏 影响因素 外科手术 

分 类 号：R657.3[医药卫生—外科学]