腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石手术困难的影响因素  

Influencing Factors of Surgical Difficulties in Laparoscopic Combined with Cholangioscopy for the Treatment of Gallstones and Common Bile Duct Stones

作　　者：王福鑫 田学昌 王明辉 WANG Fuxin;TIAN Xuechang;WANG Minghui(Department of Hepatobiliary Surgery,Ansteel Group General Hospital,Anshan,Liaoning,114000,China)

机构地区：[1]鞍钢集团公司总医院肝胆外科,辽宁鞍山114000

出　　处：《中外医疗》2025年第5期9-13,共5页China & Foreign Medical Treatment

摘　　要：目的分析腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石(common bile duct stone,CBDS)手术困难的影响因素。方法回顾性选取2023年6月—2024年6月鞍钢集团公司总医院收治的126例胆囊结石合并CBDS患者的临床资料,均采用腹腔镜联合胆道镜治疗,并根据是否存在手术困难情况分为困难组(n=56,手术时间>180 min、中转开腹、有结石残留等)与对照组(n=70,无手术困难情况)。收集整理两组患者的性别、年龄、体重指数、结石数量、结石直径、胆总管直径、胆囊壁厚度、胆道手术史、胆囊壁炎症、胆囊三角解剖位置、结石嵌顿情况等一般资料,并进行单因素分析与多因素回归分析,了解导致手术困难的相关危险因素。结果两组患者性别、年龄、结石数量、胆囊壁厚度、胆道手术史等情况比较,差异均无统计学意义(P均>0.05)。困难组体重指数≥28 kg/m^(2)、结石直径≥12 mm、胆总管直径≥12 mm、化脓/坏疽性胆囊壁炎症、胆囊三角解剖位置不清晰、胆总管下段结石嵌顿等特征患者占比高于对照组,差异均有统计学意义(P均<0.05)。经多因素回归分析得出:体重指数≥28 kg/m^(2)(OR=1.490,95%CI:1.134~1.958)、结石直径≥12 mm(OR=1.502,95%CI:1.164~1.938)、胆总管直径≥12 mm(OR=1.484,95%CI:1.021~2.157)、化脓/坏疽性胆囊壁炎症(OR=1.501,95%CI:1.143~1.971)、胆囊三角解剖位置不清晰(OR=1.501,95%CI:1.113~2.024)、胆总管下段结石嵌顿(OR=1.495,95%CI:1.039~2.151)等均为胆囊结石合并CBDS患者手术困难的危险因素(P均<0.05)。结论胆囊结石合并CBDS患者的个体特征对其手术情况存在一定影响,其中,体重指数≥28 kg/m^(2)、结石直径≥12 mm、胆总管直径≥12 mm、存在化脓/坏疽性胆囊壁炎症、胆囊三角解剖位置不清晰、胆总管下段结石嵌顿均可能增加手术困难发生风险。Objective To analyze the influencing factors of surgical difficulties in the treatment of common bile duct stones(CBDS)combined with gallstones using laparoscopy and cholangioscopy.Methods Clinical data of 126 patients with cholecystolithiasis combined with CBDS admitted to the Ansteel Group General Hospital from June 2023 to June 2024 were retrospectively selected.All patients were treated with laparoscopy combined with choledochoscopy,and were divided into the difficult group according to whether there were surgical difficulties(n=56,operation time>180 min,conversion to laparotomy,residual stone,et al.)and control group(n=70,no difficulty in operation).General data such as gender,age,body mass index,number of stones,diameter of stones,diameter of common bile duct,thickness of gallbladder wall,history of biliary surgery,inflammation of gallbladder wall,anatomical location of gallbladder tri angle,and stone incarceration of patients in the two groups were collected and sorted out.Univariate analysis and multivariate regression analysis were performed to understand the risk factors leading to surgical difficulties.Results There were no significant differences in gender,age,number of stones,thickness of gallbladder wall and history of biliary tract operation between the two groups(all P>0.05).The proportion of patients with characteristics such as body mass index≥28 kg/m^(2),stone diameter≥12 mm,common bile duct diameter≥12 mm,suppurative/gangrene inflammation of the gallbladder wall,unclear anatomical location of the gallbladder triangle,and stone intercalation in the lower common bile duct in the difficult group were higher than those in the control group,the differences were statistically significant(all P<0.05).Multivariate regression analysis showed that body mass index≥28 kg/m^(2)(OR=1.490,95%CI:1.134-1.958),stone diameter≥12 mm(OR=1.502,95%CI:1.164-1.938),common bile duct diameter≥12 mm(OR=1.484,95%CI:1.021-2.157),suppuratine/gangrenous inflammation of the gallbladder wall(OR=1.501,95%CI:1.143-1.

关 键 词：胆总管结石 胆囊结石 腹腔镜 胆道镜 手术困难 胆总管直径 

分 类 号：R657.4[医药卫生—外科学]