摘要
目的探讨经胆总管探查术后结石的残留情况及其影响因素。方法收集2016年10月至2019年12月上海市徐汇区中心医院收治的134例因胆总管结石行开腹和腹腔镜下胆总管切开取石术患者的临床资料,进行描述分析和多元回归分析。结果患者术后的结石残留率为29.9%;第一次手术取出胆总管结石>3枚者的结石残留率为42.9%,明显高于≤3枚者的结石残留率(15.6%)(χ^(2)=11.40,P<0.05);在控制手术方法、肝内胆管结石等因素后,结果显示胆总管结石数目>3枚仍与胆总管探查T管引流术后结石残留有关(P=0.001),OR值由4.050升高至4.503。结论胆总管探查术后结石残留可能与第一次术中取石超过3枚有关,胆总管探查中须加强胆道镜检查,并有效固定T管,对于术中取石数目超过3枚的患者行胆总管一期缝合须慎重。
Objective To explore the occurrence of residual stones after common bile duct exploration and its impact factors.Methods Clinical data of 134 patients with choledocholithiasis and choledocholithotomy was collected in Central Hospital of Xuhui District from Oct 2016 to Dec 2019,and descriptive analysis and multiple regression analysis were used.Results The rate of postoperative residual stone was 29.9%.The residual rate of stones was 42.9%in the patients with more than 3 stones in the first operation,which was significantly higher than that in the patients with stones≤3(15.6%)(χ^(2)=11.40,P<0.05).The number of common bile duct stones more than three was still related to the residual stones after T-tube drainage of common bile duct exploration(P=0.001),and the OR value increased from 4.050 to 4.503 after adjusting the operation method,intrahepatic bile duct stones and other factors.Conclusion The residual stones after common bile duct exploration might be related to more than 3 stones in the first operation.Choledochoscopy should be carefully strengthened in the exploration of the common bile duct,and the T tube should be effectively fixed.Primary suture of the common bile duct should be careful for patients with more than 3 stones during the operation.
作者
颜喆
陆品相
沈玉根
张正东
季文斌
YAN Zhe;LU Pin-xiang;SHEN Yu-gen;ZHANG Zheng-dong;JI Wen-bin(Department of General Surgery,Central Hospital of Xuhui District,Shanghai 200031,China)
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2021年第4期532-535,共4页
Fudan University Journal of Medical Sciences
基金
上海市科委科研计划项目(19511121303)。
