腹腔镜胆囊切除术严重并发症的危险因素及预防措施分析

目的:观察腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的严重并发症,分析其相关危险因素及预防措施。方法:回顾分析近年行LC患者的临床资料,共纳入2 584例研究对象,统计严重并发症发生率,对可能引起并发症的临床因素进行单因素及logistic多因素回归分析。结果:单因素分析结果提示急性期、胆囊壁厚度、胆囊三角电灼、Calot三角粘连、解剖变异与并发症发生率有关(P<0.05)。将有意义的因素纳入多因素logistic回归分析,按照OR值由高至低依次排列,Calot三角粘连、解剖变异、急性期、胆囊三角电灼是LC严重并发症的独立危险因素(P<0.05),而胆囊壁厚度超过5 mm不是独立危险因素。结论:正确认识危险因素,严格掌握手术适应证,规范术中操作,可降低严重并发症的发生。

Analysis of risk factors and prevention of serious complications in laparoscopic cholecystectomy

Objective：To observe the serious complication caused by laparoscopic cholecystectomy （LC） and analyze its risk factors and prevention measures. Methods：The clinical data of 2 584 patients who Underwent LC were retrospectively analyzed, and all of serious complications were recorded. The risk factors of complications in LC were studied by single factor analysis and logistic multi- ple factors analysis. Results： Single factor analysis showed that acute phase, gallbladder wall thickness, Calot triangle electrocautery, ad- hesion, variation of bile duct were correlated with complications （P 〈 0.05 ）. Logistic multiple factors analysis showed that Calot triangle adhesion, anatomic variation, acute phase, electrocautery in Calot triangle were independent risk factors of serious complications in LC （ P 〈 O. 05 ）, and gallbladder wall thickness 〉 5 mm was not risk factor. Conclusions： Following measures could reduce the incidence of complications：correct understanding of the risk factors, strict mastering operative indications and normative operation.