PDF下载 ( 1500 KB)
Risk factors for biliary complications after common bile duct exploration combined with primary suture
-
摘要: 目的探讨腹腔镜胆总管探查联合一期缝合术治疗胆总管结石患者术后胆道并发症发生情况及其危险因素。方法收集2013年6月-2016年6月于咸阳市第一人民医院行胆总管探查联合一期缝合术的134例胆总管结石患者的临床资料,观察其胆道并发症,并按照Clavien-Dindo分级标准分级。对13个可能影响一期缝合术后胆道并发症的相关因素进行单因素分析,组间比较采用χ2检验,采用logistic回归分析对筛选出的变量进行多因素分析。结果术后12例患者出现胆道并发症,发生率为8.96%,其中8例胆漏,2例胆道残留结石,1例胆道狭窄,1例胆道出血。按照Clavien-Dindo分级标准,Ⅰ级3例,Ⅱ级5例,Ⅲa级2例,Ⅲb级2例。单因素分析显示术后胆道并发症的发生与血浆Alb水平、再次胆道手术、鼻胆管引流及术者经验有关（χ2值分别为4.012、4.942、4.336、5.975,P值均<0.05）,而与年龄、性别、胆红素升高、结石最大直径、结石数目、合并内科疾病、合并胆囊结石、手术方式和缝合方式无关（P值均>0.05）。多因素分析显示,再次胆道手术和...Abstract: Objective To investigate the incidence of biliary complications after laparoscopic common bile duct exploration combined with primary suture in the treatment of patients with common bile duct stones and related risk factors.Methods A total of 134 patients with common bile duct stones who underwent common bile duct exploration combined with primary suture in The First People's Hospital of Xianyang from June 2013 to June 2016 were enrolled,and biliary complications were evaluated according to the Clavien- Dindo classification.A univariate analysis was performed for 13 possible factors for biliary complications after primary suture,the chi- square test was used for comparison between groups,and a multivariate logistic regression analysis was performed for the factors screened out in the univariate analysis.Results A total of 12 patients experienced biliary complications after surgery,resulting in an incidence rate of 8.96%;among these patients,8 had bile leakage,2 had residual stones in the bile duct,1 had biliary stricture,and 1 had hematobilia.According to the Clavien- Dindo classification,3 had grade I,5 had grade II,2 had grade IIIa,and 2 had IIIb diseases.The univariate analysis showed that postoperative biliary complications were associated with plasma albumin level,biliary reoperation,nasobiliary drainage,and surgeon's experience( χ~2= 4.012,4.942,4.336,and 5.975,all P < 0.05),while they were not associated with age,sex,increased bilirubin level,maximum stone diameter,number of stones,medical diseases,gallstones,surgical procedure,and suture method( all P > 0.05).The multivariate analysis showed that biliary reoperation and surgeon's experience were independent risk factors for postoperative biliary complications( χ~2= 6.448 and 6.842,both P < 0.05).Conclusion There are certain risks of biliary complications after common bile duct exploration combined with primary suture,and biliary leakage is the most common complication,especially in patients undergoing biliary reoperation and when there is a lack of experience in surgeons.
-
Key words:
- choledocholithiasis /
- choledochotomy /
- primary closure /
- postoperative complications /
- risk factors
-
[1]ZHANG HW,ZHOU JP,WEI F,et al.Clinical effect of primary duct closure and T-tube drainage after laparoscopic common bile duct exploration:a comparative analysis[J].J Clin Hepatol,2016,32(6):1149-1151.(in Chinese)张海文,周建鹏,魏锋,等.腹腔镜胆总管探查术后Ⅰ期缝合和T管引流的疗效比较[J].临床肝胆病杂志,2016,32(6):1149-1151. [2]WU X,YANG Y,DONG P,et al.Primary closure versus T-tube drainage in laparoscopic common bile duct exploration:a meta-analysis of randomized clinical trials[J].Langenbecks Arch Surg,2012,397(6):909-916. [3]HUA J,LIN S,QIAN D,et al.Primary closure and rate of bile leak following laparoscopic common bile duct exploration via choledochotomy[J].Dig Surg,2015,32(1):1-8. [4]CLAVIEN PA,BARKUN J,de OLIVEIRA ML,et al.The Clavien-Dindo classification of surgical complications:five-year experience[J].Ann Surg,2009,250(2):187-196. [5]ZHANG J,HUANG X.Experience in primary suture for selective choledochotomy[J].J Pract Med,2010,26(21):3958-3960.(in Chinese)张捷,黄侠.选择性胆总管切开一期缝合的治疗体会[J].实用医学杂志,2010,26(21):3958-3960. [6]JIN F,MAO ZH.Influencing factors for the clinical effect of surgical treatment of gallstones complicated by common bile duct stones[J].Chin J Gen Surg,2013,22(5):667-670.(in Chinese)金峰,毛志海.影响胆囊结石合并胆总管结石手术治疗效果的因素分析[J].中国普通外科杂志,2013,22(5):667-670. [7]LI E,WU ZG,LI ZW,et al.Logistic regression analysis on correlated factors of bile leakage after laparoscopic choledochotomy with exploration and primary suture[J].Lingnan Mod Clin Surg,2013,13(3):205-207.(in Chinese)李恩,吴祖光,李志旺,等.腹腔镜下胆总管切开探查一期缝合术后胆漏相关因素的Logistic回归分析[J].岭南现代临床外科,2013,13(3):205-207. [8]RAO SR,PAN ZL,SHI Z.A multivariate analysis of bile leakage after laparoscopic common bile duct exploration with primary duct closure[J].Clin J Min Inv Surg,2013,13(11):982-984.(in Chinese)饶尚锐,潘忠良,石铮.腹腔镜胆总管一期缝合术后胆漏的多因素分析---血浆白蛋白水平是胆漏发生的独立危险因素[J].中国微创外科杂志,2013,13(11):982-984. [9]ZHAO DQ,ZHOU LX,TANG JY,et al.Clinical analysis of repeated operation in 265 patients with biliary diseases[J].Chin JDig Surg,2012,11(5):422-425.(in Chinese)赵登秋,周龙翔,汤建燕,等.265例胆道再次或多次手术的临床分析[J].中华消化外科杂志,2012,11(5):422-425. [10]ZHAN F,ZHANG Y,YANG XJ,et al.Primary closure of common bile duct following laparoscopic reexploration and choledocholithotomy in 31 patients with a history of biliary tract operation[J].Chin J Gen Surg,2014,29(10):756-759.(in Chinese)詹峰,张云,杨晓俊,等.既往胆道手术史患者腹腔镜胆总管探查取石术后胆总管一期缝合31例[J].中华普通外科杂志,2014,29(10):756-759. [11]SUO YS,ZHANG MZ,YIN SN,et al.Comparison of pressure changes in the common bile duct after laparoscopic common bile duct exploration with primary closure of bile duct or T-tube biliary drainage[J].Clin J Min Inv Surg,2006,6(1):21-23.(in Chinese)索运生,张明哲,尹思能,等.腹腔镜胆总管探查、一期缝合和T管引流后胆道压力变化的比较[J].中国微创外科杂志,2006,6(1):21-23. [12]NAGARAJA V,ESLICK GD,COX MR.Systematic review and metaanalysis of minimally invasive techniques for the management of cholecysto-choledocholithiasis[J].J Hepatobiliary Pancreat Sci,2014,21(12):896-901. [13]ZHANG AM,XIONG LK,YU J.Research process of primary closure after laparoscopic common bile duct exploration for choledocholithiasis[J].J Clin Surg,2015,23(12):949-951.(in Chinese)张爱民,熊良昆,余佳.腹腔镜手术一期缝合胆总管治疗胆总管结石的研究进展[J].临床外科杂志,2015,23(12):949-951. 期刊类型引用(5)
1. 康志龙，周益民，宋燕州，张昆，苏一男，魏文平，赵新，李志伟. 靶向免疫治疗联合经肝动脉灌注化疗治疗不可切除肝细胞癌的临床效果及转化治疗的影响因素. 中国医学创新. 2025(01): 47-51 . 
百度学术2. 许海明，胡永奎，梁平，钟腾猛，陆炳站. 中晚期肝癌患者经动脉化疗栓塞治疗后短期效果及长期预后的影响因素分析. 大医生. 2025(06): 27-31 . 百度学术3. 彭林辉，陈涛，徐云修修，王捷，陈捷，李永，黄拼搏，钟国平，陈茜，叶聪婷，陈亚进. mFOLFOX7方案全身化疗联合卡瑞利珠单克隆抗体和阿帕替尼治疗肝细胞癌合并Vp4型门静脉癌栓的疗效. 中华消化外科杂志. 2024(02): 265-271 . 百度学术4. 李洁，李瑞娟，鲁志兵，曾筱怡. 肝动脉灌注化疗联合程序性死亡受体1抗体及仑伐替尼治疗晚期肝癌合并门静脉癌栓的效果. 中国当代医药. 2024(26): 43-46+51 . 百度学术5. 黄乾鑫，神斌，肖晋昌，高志康，吕墩涛，李艳，徐浩，张庆桥. 载药微球经导管动脉化疗栓塞术联合肠系膜上动脉灌注化疗治疗肝细胞癌合并门静脉癌栓的效果分析. 临床肝胆病杂志. 2024(12): 2457-2463 . 
本站查看其他类型引用(0)
-
百度学术
下载:
