局解手术学杂志2024,Vol.33Issue(10) :844-848.DOI:10.11659/jjssx.06E024022

腹腔镜下胆总管探查术一期缝合后胆漏的危险因素分析

Analysis of risk factors for bile leakage after laparoscopic common bile duct exploration with primary closure

郭午 刘军舰 尚海涛 张德林 张西波 李忠廉
局解手术学杂志2024,Vol.33Issue(10) :844-848.DOI:10.11659/jjssx.06E024022

腹腔镜下胆总管探查术一期缝合后胆漏的危险因素分析

Analysis of risk factors for bile leakage after laparoscopic common bile duct exploration with primary closure

郭午 1刘军舰 2尚海涛 2张德林 2张西波 2李忠廉2
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作者信息

  • 1. 天津市海河医院普通外科,天津 300222
  • 2. 天津市中西医结合医院肝胆胰外科二,天津 300100
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摘要

目的 探讨腹腔镜下胆总管探查术(LCBDE)一期缝合后胆漏发生的危险因素.方法 回顾性分析2021年9月至2023年9月因胆总管结石于天津市中西医结合医院行LCBDE一期缝合的560例患者的临床资料,根据术后是否发生胆漏将患者分为胆漏组和未胆漏组.多因素分析影响术后胆漏发生的危险因素.结果 共64例(11.4%)患者发生了不同程度的胆漏,其中A级胆漏 55例,B级 7例,C级 2例.胆总管直径较小(OR=0.07,P<0.001)、高血压史(OR=4.56,P<0.001)及BMI较高(OR=1.17,P=0.002)是胆总管结石患者术后胆漏发生的危险因素.结论 胆总管直径较小、合并高血压和肥胖的患者术后更易发生胆漏,对于存在上述危险因素的胆总管结石患者,应谨慎选择LCBDE一期缝合.

Abstract

Objective To explore the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)with primary closure.Methods The clinical data of 560 patients with choledocholithiasis who underwent LCBDE with primary closure in Tianjin Hospital of Integrated Traditional Chinese and Western Medicine from September 2021 to September 2023 were retrospectively analyzed,and the patients were divided into the bile leak group and the non-bile leak group according to the occurrence of postoperative bile leakage.The risk factors affecting the occurrence of postoperative bile leakage were analyzed by multivariate analysis.Results A total of 64 cases(11.4% )experienced varying degrees of bile leakage,including 55 cases of grade A bile leakage,7 cases of grade B,and 2 cases of grade C.The thin common bile duct(OR=0.07,P<0.001),history of hypertension(OR=4.56,P<0.001),and high BMI(OR=1.17,P=0.002)were the risk factors for postoperative bile leakage in patients with choledocholithiasis.Conclusion Patients with thin common bile duct,hypertension and obesity are more likely to occur postoperative bile leakage.Patients with choledocholithiasis who have the above high-risk factors should be cautious in choosing LCBDE with primary closure.

关键词

腹腔镜/胆总管一期缝合/胆漏/危险因素/胆总管结石

Key words

laparoscope/primary closure of common bile duct/bile leakage/risk factors/choledocholithiasis

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基金项目

天津市卫生健康委员会中医药重点领域科研项目(2019003)

天津市教委科研计划项目(2022KJ271)

出版年

2024
局解手术学杂志
重庆市解剖学会,第三军医大学

局解手术学杂志

CSTPCD
影响因子:1.063
ISSN:1672-5042
参考文献量6
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