摘要
目的分析腹腔镜胆囊切除术患者胆管损伤危险因素。方法回顾性分析山西省人民医院2010年2月至2018年2月接受腹腔镜胆囊切除术治疗的7984例患者的临床资料,记录其人口学资料,采用单因素与多因素分析的方法找出影响其胆管损伤的高危因素。结果7984例腹腔镜胆囊切除术患者中,50例出现胆管损伤,胆管损伤率为0.63%;经单因素分析发现,胆囊壁厚度、胆囊三角解剖变异、胆囊炎症分期、术中粘连、胆管异常解剖、胆囊管长度是影响腹腔镜胆囊切除术患者术中术后胆管损伤的危险因素,差异有统计学意义(P<0.05)。经多因素分析发现,胆囊壁厚度≥3mm、胆囊三角解剖区变异、胆囊急性炎症、术中粘连紧密、导管异常解剖、胆囊管长度≤10mm是影响腹腔镜胆囊切除术术中及术后胆管损伤的独立危险因素(OR>1,P<0.05)。结论胆囊壁较厚、胆囊三角解剖异常、胆囊急性炎症、术中粘连严重、胆囊管长度较短、胆囊异常解剖等均是导致腹腔镜胆囊切除患者胆管损伤的独立危险因素,在实际操作中医护人员应根据患者具体情况,评估其胆管损伤危险因素,选择最为安全可靠的入路、麻醉等操作,降低胆管损伤风险,提高手术安全性。
Objective To analyze the risk factors of bile duct injury in patients after laparoscopic cholecystectomy.Methods The clinical data of 7984 patients who underwent laparoscopic cholecystectomy from February 2010 to February 2018 were retrospectively analyzed.The demographic data were recorded and the risk factors of bile duct injury were identified by single factor and multifactor analysis.Results Among the 7984 cases of laparoscopic cholecystectomy,50 cases had bile duct injury,and the rate of bile duct injury was 0.63%.Univariate analysis showed that the thickness of gallbladder wall,anatomical variation of gallbladder triangle,stages of gallbladder inflammation,intraoperative adhesion,abnormal anatomy of bile duct and length of gallbladder duct were the factors affecting the operation of laparoscopic cholecystectomy.The risk factors of postoperative bile duct injury were significant(P<0.05).Multivariate analysis showed that the thickness of gallbladder wall(≥3 mm),variation of gallbladder triangle anatomy area,acute inflammation of gallbladder,tight intraoperative adhesion,abnormal catheter anatomy,length of gallbladder duct(≤10 mm)were the factors affecting bile duct during and after laparoscopic cholecystectomy(OR>1,P<0.05).Conclusions Thicker gallbladder wall,abnormal gallbladder triangle anatomy,acute gallbladder inflammation,severe intraoperative adhesion,shorter cystic duct length and abnormal gallbladder anatomy are independent risk factors for bile duct injury in patients who underwent laparoscopic cholecystectomy.In practice,medical staff should evaluate the risk of bile duct injury according to the specific conditions of patients,select the most safe and reliable approach of anesthesia and other operations to reduce the risk of bile duct injury and improve the safety of surgery.
作者
贺艳平
底卫东
He Yanping;Di Weidong(Department of General Surgery,the People’s Hospital of Shanxi,Taiyuan 030012,China)
出处
《中国实用医刊》
2019年第4期25-27,共3页
Chinese Journal of Practical Medicine
关键词
腹腔镜胆囊切除术
胆管损伤
危险因素
Laparoscopic cholecystectomy
Bile duct injury
Risk factors
