重度急性胆囊炎患者超声引导下经皮经肝胆囊穿刺置管引流术后新发胆总管结石的危险因素分析  

Risk factors of new choledocholithiasis in patients with severe acute cholecystitis after ultrasound-guided percutaneous transhepatic gallbladder drainage

作　　者：李霄阳 叶永强 王琛 王安伟 刘涛 孔杰 王宏超 陈鹏 LI Xiaoyang;YE Yongqiang;WANG Chen;WANG Anwei;LIU Tao;KONG Jie;WANG Hongchao;CHEN Peng(Graduate Department,Shandong First Medical University,Jinan 250117,China;不详)

机构地区：[1]山东第一医科大学研究生部,山东济南250117 [2]山东第一医科大学附属菏泽医院肝胆外科,山东菏泽274607

出　　处：《山东医药》2025年第3期64-68,共5页Shandong Medical Journal

摘　　要：目的分析重度急性胆囊炎患者超声引导下经皮经肝胆囊穿刺置管引流术(PTGD)后新发胆总管结石的危险因素。方法选择行PTGD的重度急性胆囊炎患者140例,PTGD后随访至少2个月,其中新发胆总管结石26例(新发组)、无新发胆总管结石114例(对照组)。比较两组的一般情况[性别、年龄、饮酒史、身体质量指数(BMI)、胆囊炎病史、术前抗炎治疗及发热、寒战情况、基础疾病]、术前实验室检查相关指标[白细胞计数、中性粒细胞百分比、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、谷氨酰转肽酶、碱性磷酸酶、C反应蛋白、总胆红素、直接胆红素、血小板计数、活化部分凝血活酶时间(APTT)]、术前影像学检查相关指标(胆囊壁厚度、胆总管直径、胆囊结石单/多发、胆囊结石性状、胆囊管汇入胆总管异常、胰胆管合流异常、Mirizzi综合征、胆周积液)以及带管时间。采用多因素Logistic回归分析差异有统计学意义的指标对重度急性胆囊炎患者行PTGD后新发胆总管结石的影响。结果两组一般情况相关指标比较差异均无统计学意义(P均>0.05)。两组术前白细胞计数、中性粒细胞百分比、ALT、AST、谷氨酰转肽酶、碱性磷酸酶、C反应蛋白、总胆红素、直接胆红素、APTT比较差异均无统计学意义(P均>0.05),新发组血小板计数低于对照组(P<0.05)。新发组胆囊结石多发、胆囊管汇入胆总管异常的比例及胆总管直径均高于对照组(P均<0.05),两组胆囊壁厚度比较差异无统计学意义(P>0.05)。新发组和对照组带管时间分别为(24.69±2.32)、(16.75±4.79)d,新发组带管时间长于对照组(P<0.05)。多因素Logistic回归分析结果显示,胆囊结石多发(OR=9.429,95%CI:1.904~46.694)、胆囊管汇入胆总管异常(OR=11.282,95%CI:2.698~47.186)、胆总管直径升高(OR=1.590,95%CI:1.246~2.030)和带管时间延长(OR=1.677,95%CI:1.267~2.220)均是影响重度急Objective To analyze the risk factors of new choledocholithiasis in patients with severe acute cholecystitis after ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGD).Methods Totally 140 patients with severe acute cholecystitis who received PTGD were followed up for at least 2 months after PTGD,including 26 patients with new choledocholithiasis(new group)and 114 patients without new choledocholithiasis(control group).The general information[gender,age,drinking history,body mass index(BMI),history of cholecystitis,preoperative anti-inflammatory therapy,fever,chills,and underlying diseases],and the relevant indexes of preoperative laboratory examination[white blood cell count,neutrophil percentage,alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptide,alkaline phosphatase,C-reactive protein,total bilirubin,direct bilirubin,platelet count,activated partial thrombin time(APTT)],preoperative imaging indicators[gallbladder wall thickness,common bile duct diameter,single/multiple gallstones,gallstone characteristics,abnormal union of the cystic duct into the common bile duct,abnormal pancreatitis and bile duct confluence,Mirizzi syndrome,and peribile effusion]and intubation time were compared between these two groups.Multifactor Logistics regression was used to analyze the risk factors of new choledocholithiasis in patients with severe acute cholecystitis after PTGD.Results There were no significant differences in the relevant indicators between the two groups(all P>0.05).There were no significant differences in the percentage of leukocytes,neutrophils,ALT,AST,glutamyltranspeptides,alkaline phosphatase,C-reactive protein,total bilirubin,direct bilirubin or APTT between the two groups before surgery(all P>0.05).The platelet count in the new group was lower than that in the control group(P<0.05).The proportions of multiple cholecystolithiasis,abnormal union of the cystic duct into the common bile duct and cholecystectomy diameter in the new group were higher than those in th

关 键 词：重度急性胆囊炎 胆囊穿刺置管引流术 胆总管结石 多发性胆囊结石 胆囊管汇入胆总管异常 胆总管扩张 带管时间 

分 类 号：R619[医药卫生—外科学]