胆囊结石腹腔镜切除术后并发胆源性胰腺炎的因素探讨

目的:探讨胆囊结石腹腔镜切除术后并发胆源性胰腺炎的危险因素,为胆囊结石腹腔镜切除术临床应用提供参考。方法:随机抽样调查2017年3月至2019年3月本院行腹腔镜切除术的214例胆囊结石病例。收集病例一般资料、术后并发胆源性胰腺炎情况、胆囊结石病理情况、治疗相关因素等,单因素分析法分析一般资料、胆囊结石病理情况、治疗相关因素对术后并发胆源性胰腺炎的影像,多因素分析法分析术后并发胆源性胰腺炎的危险因素。结果:单因素分析结果显示:并发胆源性胰腺炎者和未并发胆源性胰腺炎者在一般资料(体质指数、急性胆源性胰腺炎病史、饮酒、血白蛋白、血脂、血肌酐)、胆囊结石病理因素(胆囊大小、胆囊壁厚度、胆囊结石多寡、胆囊结石大小、合并胆总管结石)、治疗相关因素(医师临床经验、应用球囊扩张、术中导丝多次进入胰管)等方面比较差异均无统计学意义(P>0.05)。多因素分析结果显示:体质指数(OR=-1.097,P=0.015)、急性胆源性胰腺炎病史(OR=-0.408,P=0.004)、合并胆总管结石(OR=-4.342,P=0.000)、医师临床经验(OR=-3.215,P=0.000)、胆囊壁厚度分布(OR=4.793,P=0.000)、术中导丝多次进入胰管(OR=3.821,P=0.003)、球囊扩张应用(OR=3.403,P=0.001)是腹腔镜胆囊切除术并发胆源性胰腺炎的独立危险因素。结论:高体质指数、急性胆源性胰腺炎病史、合并胆总管结石、医师临床经验≤5年、胆囊壁厚度>3 mm、术中导丝多次进入胰管、球囊扩张应用是腹腔镜胆囊切除术并发胆源性胰腺炎的独立危险因素,临床必须予以高度重视。

Study on the factors of biliary pancreatitis after laparoscopic cholecystolithotomy

Objective:To explore the risk factors of gallstone pancreatitis after laparoscopic cholecystectomy,and to provide reference for clinical application of laparoscopic cholecystectomy.Methods:214 cases of cholecystolithiasis(case source:laparoscopic surgery in our hospital From March 2017 to March 2019)were randomly selected for investigation.The general baseline data,postoperative biliary pancreatitis,gallstone pathology and treatment related factors were collected.The image of postoperative biliary pancreatitis was analyzed by single factor analysis,and the risk factors of postoperative biliary pancreatitis were analyzed by multi factor analysis.Results:Univariate analysis showed that:baseline data(body fat ratio,history of acute gallstone pancreatitis,alcohol consumption,albumin,lipid,creatinine),pathological factors of gallstone(abnormal gallbladder size,thickness distribution of gallbladder wall,number distribution of gallstone,size distribution of gallstone,and combination of gallstone)in patients with and without gallstone pancreatitis(The distribution of choledocholithiasis)and the treatment related factors(the distribution of clinical experience of doctors,whether to use balloon dilatation,whether the guide wire repeatedly entered the pancreatic duct)were compared(P>0.05).Multivariate analysis showed that:body fat ratio(or=-1.097,P=0.015),history of acute biliary pancreatitis(or=-0.408,P=0.004),choledocholithiasis(or=-4.342,P=0.000),clinical experience of doctors(or=-3.215,P=0.000),thickness distribution of gallbladder wall(or=4.793,P=0.000),multiple access of guide wire into pancreatic duct(or=3.821,P=0.003),balloon dilatation application(or=3.403,P=0.0001)is an independent risk factor for laparoscopic cholecystectomy complicated with biliary pancreatitis.Conclusion:Body fat ratio,history of acute gallstone pancreatitis,choledocholithiasis,clinical experience of doctors,thickness distribution of gallbladder wall,multiple access of guide wire to pancreatic duct during operation,and application of balloon dilatation are independent risk factors for laparoscopic cholecystectomy complicated with gallstone pancreatitis,which should be paid great attention to in clinic.