目的 探讨单中心先天性胆总管囊肿(CCC)根治术术后早期并发症影响因素，为减少术后并发症提供一定临床依据及指导。 方法 病例对照研究。分析遵义医科大学附属医院2010年9月至2019年10月诊断明确并已行根治术的124例CCC患儿的临床资料，男29例，女95例，根据术后是否发生并发症(胆漏、肠肠吻合口瘘、出血、切口裂开、胆管炎、腹腔感染、胰腺炎、淋巴瘘)分为并发症组(A组)和无并发症组(B组)，对2组患儿的年龄、实验室指标(术前白细胞计数、血红蛋白、丙氨酸转氨酶、前白蛋白及术后白蛋白)以及2组患儿手术方式、手术时间、术中失血量、囊肿类型、囊肿直径、肝总管直径，是否合并腹部手术史、胆泥结石、肝胆管解剖变异、胆胰合流等相关临床因素进行统计分析，并对其中的计量资料符合正态分布的行t检验，非正态分布行非参数秩和检验，多因素分析采用Logistic回归分析。 结果 124例手术病例发生并发症25例(20。16%)，未发生并发症99例(79。84%)，其中胆漏14例(11。29%)，7例再次手术，7例保守治愈；肠肠吻合口瘘2例(1。61%)，1例再次手术，1例保守治愈；出血1例(0。81%)，再次手术治愈；切口裂开2例(1。61%)，1例再次手术，1例保守治愈；胆管炎2例(1。61%)、腹腔感染2例(1。61%)、胰腺炎1例(0。81%)、淋巴瘘1例(0。81%)均保守治愈。其中非正态分布指标：2组年龄及白细胞计数比较，差异均无统计学意义(均P>0。05)；2组失血量及囊肿直径比较，差异均有统计学意义(均P<0。05)；符合正态分布指标的术后白蛋白(27。84±4。62) g/L比(32。45±3。72) g/L，2组比较差异有统计学意义(t＝5。254，P<0。05)。Logistic多因素回归分析：术前贫血(OR＝7。922，95%CI：1。468～42。757)、合并胆泥结石(OR＝1。295，95%CI：1。075～4。359)是术后并发症发生的独立危险因素，术后白蛋白(OR＝0。055，95%CI：0。012～0。244)是术后并发症发生的保护因素，差异均有统计学意义(均P<0。05)。 结论 胆总管囊肿直径越大、术中出血量越多，越增加手术风险。术前纠正贫血、术中精细操作清理肝胆管淤泥、减少出血及加强围术期白蛋白、血红蛋白的监测，可预防及减少CCC根治术后早期并发症发生。 Objective To explore the influencing factors of early postoperative complications after radical resection of congenital choledochal cyst (CCC) in a single center and provide some clinical basis and guidance for reducing postoperative complications。 Methods Case control study。Clinical data of 124 children (29 boys and 95 girls) with CCC diagnosed and radically treated at the Affiliated Hospital of Zunyi Medical University from September 2010 to October 2019 were analyzed。According to postoperative complications (bile leakage， gastrointestinal anastomotic fistula， bleeding， incision dehiscence， cholangitis， abdominal infection， pancreatitis， and lymphatic fistula)， these children were divided into the complication group (group A) and non-complication group (group B)。 Age， laboratory indicators[preoperative white blood cell (WBC) count， hemoglobin， glutamic pyruvic transaminase， prealbumin， and postoperative albumin]， and clinical factors， such as operation method， operation time， intraoperative blood loss， cyst type， cyst diameter， hepatic duct diameter， abdominal operation history， biliary sludge and calculus， hepatic duct anatomic variation， and pancreaticobiliary maljunction were statistically analyzed between the two groups。The t-test was performed for normal distribution of the measurement data， and the non-parametric rank sum test for non-normal distribution。Multivariate analysis was made using Logistic regression。 Results Among the 124 children， 25(20。16%) had complications， and 99(79。84%) had no complications。Bile leakage occurred in 14 children (11。29%)， of whom 7 received operation again and 7 received conservative treatment。Gastrointestinal anastomotic fistula occurred in 2 children (1。61%)， of whom 1 was re-operated and 1 was cured conservatively。One child (0。81%) was complicated with bleeding and cured by re-operation。Two children (1。61%) were complicated with incision dehiscence， of whom 1 was cured by re-operation and 1 was cured by conservative treatment。Cholangitis in 2 children (1。61%)， abdominal infection in 2 children (1。61%)， pancreatitis in 1 child (0。81%)， and lymphatic fistula in 1 child (0。81%) were all conservatively cured。No significant difference was found in non-normal distribution indicators-age and WBC count-between the two groups (all P>0。05)。 Blood loss volume and cyst diameter were significantly different between the two groups (allP<0。05)。 Postoperative albumin[(27。84±4。62) g/Lvs。(32。45±3。72) g/L] meeting the normal distribution showed a statistically significant difference between the two groups (t=5。254， P<0。05)。 Logistic multivariate regression analysis suggested that preoperative anemia (OR=7。922， 95%CI: 1。468-42。757) and biliary sludge and calculus (OR=1。295， 95%CI: 1。075-4。359) were independent risk factors for postoperative complications postoperative albumin (OR=0。055， 95%CI: 0。012-0。244) was a protective factor for postoperative complications， and the differences were statistically significant (all P<0。05)。 Conclusions The larger the cyst diameter， the more the intraoperative bleeding， and the higher the risk of operation。Treating anemia before operation， clearing sludge in the hepatic duct during operation， reducing bleeding， and strengthening the monitoring of albumin and hemoglobin during the perioperative period can prevent and reduce early complications after radical resection of CCC in children。
Analysis of influencing factors and treatment experience of early postoperative complications after radical resection of congenital choledochal cyst in a single center
Objective To explore the influencing factors of early postoperative complications after radical resection of congenital choledochal cyst (CCC) in a single center and provide some clinical basis and guidance for reducing postoperative complications. Methods Case control study.Clinical data of 124 children (29 boys and 95 girls) with CCC diagnosed and radically treated at the Affiliated Hospital of Zunyi Medical University from September 2010 to October 2019 were analyzed.According to postoperative complications (bile leakage, gastrointestinal anastomotic fistula, bleeding, incision dehiscence, cholangitis, abdominal infection, pancreatitis, and lymphatic fistula), these children were divided into the complication group (group A) and non-complication group (group B). Age, laboratory indicators[preoperative white blood cell (WBC) count, hemoglobin, glutamic pyruvic transaminase, prealbumin, and postoperative albumin], and clinical factors, such as operation method, operation time, intraoperative blood loss, cyst type, cyst diameter, hepatic duct diameter, abdominal operation history, biliary sludge and calculus, hepatic duct anatomic variation, and pancreaticobiliary maljunction were statistically analyzed between the two groups.The t-test was performed for normal distribution of the measurement data, and the non-parametric rank sum test for non-normal distribution.Multivariate analysis was made using Logistic regression. Results Among the 124 children, 25(20.16%) had complications, and 99(79.84%) had no complications.Bile leakage occurred in 14 children (11.29%), of whom 7 received operation again and 7 received conservative treatment.Gastrointestinal anastomotic fistula occurred in 2 children (1.61%), of whom 1 was re-operated and 1 was cured conservatively.One child (0.81%) was complicated with bleeding and cured by re-operation.Two children (1.61%) were complicated with incision dehiscence, of whom 1 was cured by re-operation and 1 was cured by conservative treatment.Cholangitis in 2 children (1.61%), abdominal infection in 2 children (1.61%), pancreatitis in 1 child (0.81%), and lymphatic fistula in 1 child (0.81%) were all conservatively cured.No significant difference was found in non-normal distribution indicators-age and WBC count-between the two groups (all P>0.05). Blood loss volume and cyst diameter were significantly different between the two groups (allP<0.05). Postoperative albumin[(27.84±4.62) g/Lvs.(32.45±3.72) g/L] meeting the normal distribution showed a statistically significant difference between the two groups (t=5.254, P<0.05). Logistic multivariate regression analysis suggested that preoperative anemia (OR=7.922, 95%CI: 1.468-42.757) and biliary sludge and calculus (OR=1.295, 95%CI: 1.075-4.359) were independent risk factors for postoperative complications postoperative albumin (OR=0.055, 95%CI: 0.012-0.244) was a protective factor for postoperative complications, and the differences were statistically significant (all P<0.05). Conclusions The larger the cyst diameter, the more the intraoperative bleeding, and the higher the risk of operation.Treating anemia before operation, clearing sludge in the hepatic duct during operation, reducing bleeding, and strengthening the monitoring of albumin and hemoglobin during the perioperative period can prevent and reduce early complications after radical resection of CCC in children.
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