腹腔镜下胆囊切除术治疗胆囊结石患者术后胰腺炎发生情况及其影响因素分析  

Analysis of the Occurrence of Postoperative Pancreatitis in Patients with Gallbladder Stones Treated by Laparoscopic Cholecystectomy and Its Influencing Ffactors

作　　者：李丹丹 骆伟 丁方回 LI Dandan;LUO Wei;DING Fanghui(Department of General Surgery,The First Hospital of Lanzhou University,Lanzhou 730030,Gansu,China)

机构地区：[1]兰州大学第一医院普外科,甘肃兰州730030

出　　处：《系统医学》2025年第6期130-133,共4页Systems Medicine

摘　　要：目的探讨胆囊结石患者行腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)术后胰腺炎发生情况及其影响因素分析。方法回顾性选取2022年9月—2024年3月兰州大学第一医院普外科收治的100例LC患者的诊疗资料。根据术后胰腺炎的发生情况分为发生组(10例)和未发生组(90例)。分析胆囊结石患者的临床特征、住院期间并发症、手术相关指标及既往病史等,并采用Logistic回归分析发生胰腺炎的独立危险因素。结果通过多因素Logistic回归分析显示,年龄≤60岁、未合并高脂血症、手术时间短、胆囊大小正常、颗粒状结石、无胰腺病史等因素为胆囊结石患者行LC术后胰腺炎发生的保护因素(OR=0.211、0.333、0.329、0.017、0.347、0.359,P均<0.05);而胆囊壁厚度≤3 mm、同型半胱氨酸(homocysteine,Hcy)高水平、降钙素原(procalcitonin,PCT)高水平则为该患者群体LC术后发生胰腺炎的独立危险因素(OR=5.540、5.089、3.773,P均<0.05)。结论胆囊结石患者LC术后,其中年龄低、无高脂血症、无胰腺病史且结石颗粒状、手术时间更短的患者患胰腺炎发生风险较低;胆囊壁厚度较薄,Hcy与PCT持续升高的情况下,胰腺炎发生风险增加,临床应引起重视,制订术前、术中预防及干预措施,术后及时发现并及时治疗。Objective To study the incidence of pancreatitis after laparoscopic cholecystectomy(LC)in patients with gallstones and to analyse the influencing factors.Methods From September 2022 to March 2024,the diagnosis and treatment date of 100 patients with LC admitted to the Department of General Surgery of The First Hospital of Lan-zhou University were retrospectively selected.According to the occurrence of postoperative pancreatitis,they were di-vided into the occurrence group(10 cases)and the non-occurrence group(90 cases).The clinical characteristics,com-plications during hospitalization,surgical related indicators and past medical history of patients with gallstones were analyzed.Logistic regression analysis was used to screen the independent risk factors affecting the occurrence of pan-creatitis.Results Multivariate logistic regression analysis showed that factors such as age≤60 years old,no hyperlipid-emia,shorter operation time,normal gallbladder size,granular stones,and no history of pancreas were protective fac-tors for pancreatitis after LC in patients with gallstones(OR=0.211,0.333,0.329,0.017,0.347,0.359,all P<0.05).Gallbladder wall thickness≤3 mm,high homocysteine(Hcy)level,and high procalcitonin(PCT)level were independent risk factors for pancreatitis after LC in patient with gallstones(OR=5.540,5.089,3.773,all P<0.05).Conclusion After LC in patients with gallstones,the risk of pancreatitis is lower in patients with low age,no hyperlipidemia,no history of pancreas,granular stones,and shorter operation time.In the case of thin gallbladder wall and continuous increase of Hcy and Pct,the risk of pancreatitis is greatly increased.Clinical attention should be paid to the prevention and inter-vention measures before and during operation,and timely detection and treatment after operation.

关 键 词：腹腔镜下胆囊切除术 胆囊结石 术后胰腺炎 

分 类 号：R4[医药卫生—临床医学]