急性胆囊炎早期腹腔镜治疗术后并发症的高危因素分析

目的:探讨急性胆囊炎早期行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后并发症的相关因素。方法:回顾分析2009年1月至2013年12月737例早期行LC的急性胆囊炎患者的临床资料,应用Logistic多因素回归分析术后并发症的相关危险因素。结果:LC术后15例(2.04%)早期出现并发症,6例再次手术治疗,9例保守治疗,均治愈。单因素分析显示早期LC术后并发症的发生与既往病程、是否为结石性胆囊炎、胆囊三角解剖变异、术者经验及出血量有关(P0.05),与性别、年龄、肥胖、合并内科疾病、胆囊颈结石嵌顿、胆囊萎缩及放置腹腔引流管无关(P0.05)。多因素分析显示既往病程、术者经验是早期LC术后并发症的独立危险因素(P0.05)。结论:急性胆囊炎患者LC术后早期容易发生并发症与既往病程较长、术者经验少相关,术者应加强训练,严格把握手术适应证及中转开腹指征。     

腹腔镜胆囊切除术并发症发生的相关影响因素分析

目的:分析腹腔镜胆囊切除术(LC)并发症的各种危险因素。方法:收集2012年9月—2014年9月期间院行LC术的312例患者临床资料,分析术后出现并发症发生情况及相关危险因素。结果:共有81例患者出现并发症(25.96%),其中胆囊破裂22例(7.05%),腹腔出血28例(8.97%),肝动脉损伤17例(5.45%),胆瘘14例(4.48%);单因素分析结果显示,Calot三角粘连、解剖变异、急性期、Calot三角区电灼及胆囊壁厚度超过5 mm与LC并发症的发生有关(均P0.05);多因素分析结果显示,Calot三角出现粘连(OR=3.466,95%CI=1.432~8.389)、局部解剖变异(OR=1.988,95%CI=1.237~3.194)及术中采取Calot三角电灼切除(OR=1.089,95%CI=1.015~1.168)是LC并发症发生的独立危险因素(均P0.05)。结论:LC术前应完善相关检查,了解患者存在的危险因素,避免使用Calot三角区电灼切除,以减少术后并发症的发生。     

老年患者腹腔镜胆囊切除术并发症发生的相关危险因素分析

目的:探讨老年患者腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)并发症发生情况及其相关危险因素,为LC并发症的防治提供可借鉴依据。方法:收集2013年4月至2016年4月783例行LC的老年患者的临床资料,分析并发症情况,并采用单因素及多因素分析的方法筛选并发症发生的相关危险因素。结果:并发症总发生率为4.47%(35/783),单因素回归分析结果显示,病程、专科手术经验、手术时间、胆囊壁厚度、胆囊与周围粘连、Calot三角粘连、胆囊颈结石、解剖变异、放置引流、合并基础疾病等10个因素与并发症密切相关。多因素分析表明,影响并发症发生的因素包括专科手术经验(OR=2.954)、胆囊壁厚度(OR=2.496)、胆囊与周围粘连(OR=3.286)、Calot三角粘连(OR=4.212)、放置引流(OR=0.321)、合并基础疾病(OR=4.532)。结论:老年患者行LC的并发症发生率仍较高,手术并发症发生的影响因素较多,临床应提高防范意识,采取针对性的预防措施,以降低并发症发生率,改善患者预后。     

腹腔镜胆囊切除术联合腹腔镜胆总管探查术中转开腹的危险因素探讨及临床分析

目的:探讨行腹腔镜胆囊切除术(LC)联合腹腔镜胆总管探查术(LCBDE)治疗胆囊结石合并胆总管结石时中转开腹的危险因素并进行相关临床分析。方法:回顾性分析2014年1月—2018年6月期间197例行LC+LCBDE患者的临床资料,筛选中转开腹手术的危险因素,并比较完成腹腔镜手术患者与中转开腹患者围术期指标及术后并发症情况。结果:197例中15例(7.6%)中转开腹。单因素与多因素回归分析结果显示,血清总胆红素17.1μmol/L(OR=5.156,P=0.032)、胆囊壁厚度6mm(OR=7.971,P=0.012)、黄疸(OR=10.715,P=0.002)、胆总管下段结石嵌顿(OR=20.203,P=0.003)是中转开腹的独立危险因素。以上4种因素组合所建立回归方程预测中转开腹的ROC曲线下面积为0.891,敏感度为80.0%,特异度为98.9%。与中转开腹患者比较,完成腹腔镜手术患者手术时间、术中出血量、术后镇痛剂使用次数、术后抗生素使用时间、术后肛门排气时间、住院时间、住院费用、并发症发生率均明显减少(均P0.05)。结论:对于LC+LCBDE患者,应仔细评估上述4种独立危险因素,这对于完善术前准备、选择手术方式,降低开放手术转化率,以及改善患者预后具有重要意义。     

单孔腹腔镜胆囊切除术的并发症及影响因素分析

目的:探讨单孔腹腔镜胆囊切除术(SILC)并发症及其影响因素。方法:收集2011年1月至2019年6月收治的977例行SILC患者的临床资料,分析并发症发生情况及相关影响因素。先后采用χ~2检验与多因素logistic回归分析SILC并发症的19个相关因素。结果:本组共21例患者出现并发症,发生率为2.15%。χ~2检验结果显示,并发症与Calot三角粘连、胆囊区解剖变异、急性期、腹部手术史及胆囊壁厚度超过5 mm有关(P<0.05)。多因素Logistic回归分析结果显示,Calot三角粘连(P<0.05,OR=6.537)、胆囊区解剖变异(P<0.05,OR=5.253)、腹部手术史(P<0.05,OR=4.762)、胆囊壁厚度(P<0.05,OR=4.318)是SILC并发症发生的危险因素。结论:术前充分评估围术期可能存在的危险因素,以降低并发症发生率,提高SILC的安全性。     

腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石手术困难因素分析及临床对策

目的:探讨腹腔镜联合胆道镜治疗胆囊结石合并胆总管结石的困难因素,并提出相应的临床对策。方法:回顾分析2013年9月至2018年10月为116例患者行腹腔镜胆囊切除(LC)联合腹腔镜胆总管探查(LCBDE)的临床资料,按手术时间、是否中转开腹、有无结石残留分组,应用单因素分析及多因素Logistic回归分析,探讨LC联合LCBDE手术困难的独立危险因素。结果:116例患者中容易组63例、困难组53例。单因素分析显示:胆囊大小、胆囊壁炎症严重程度、胆囊三角解剖关系显露情况、胆总管下段有无结石嵌顿及胆总管直径均是LC联合LCBDE手术难度较大的危险因素(P<0.05)。多因素Logistic回归结果显示,胆囊三角显露不清(OR=14.090,P<0.001)、胆囊壁化脓坏疽(OR=20.057,P=0.011)、胆总管下段结石嵌顿(OR=23.001,P=0.006)及胆总管直径≥12 mm(OR=3.950,P=0.008)是LC联合LCBDE手术困难的独立危险因素。结论:胆囊结石合并胆总管结石伴有胆囊三角显露不清、胆囊壁化脓坏疽、胆总管下段结石嵌顿、胆总管直径≥12 mm时,LC联合LCBDE的手术困难、危险性明显增加,临床应重视此类患者的术前评估及术中操作,以降低手术困难发生率。     

腹腔镜直肠前切除术后并发症及其相关因素分析

目的分析腹腔镜直肠前切除术后并发症发生率及其相关危险因素,进一步预防术后并发症的发生。方法回顾性分析解放军总医院普通外科2013年1月至2016年6月间施行腹腔镜直肠前切除术的663例病人的临床资料,观察术后并发症发生情况,对发生术后并发症的危险因素进行分析,分析并发症组与无并发症组临床资料的差异性。结果全组663例病人出现并发症76例(11.5%);单因素分析显示:病人的性别、肥胖、术前合并症、肿瘤位置、淋巴结清扫数目、TNM分期、手术时间与腹腔镜直肠前切除术后并发症相关(P0.05)。多因素回归分析显示:性别(OR=2.120,95%CI:1.150~3.909)、术前合并症(OR=2.618,95%CI:1.483~4.621)、肿瘤位置(OR=10.338,95%CI:5.672~18.842)、TNM分期(OR=3.111,95%CI:1.774~5.457)是影响术后并发症发生的独立危险因素(均P0.05)。结论性别、术前合并症、肿瘤位置、TNM分期是腹腔镜直肠前切除术后并发症发生的危险因素,腹腔镜直肠前切除术后并发症以吻合口瘘常见。     

腹腔镜胆囊切除术并发症发生率及其影响因素

目的:探讨腹腔镜胆囊切除术(LC)患者手术并发症的发生率和影响因素.方法:采用自编调查表,回顾性分析近两年间收治的500例LC患者临床资料,分析手术并发症的发生率和影响因素.结果:LC并发症发生率为2.60％,单因素Logistic回归分析显示,LC并发症与高龄、手术性质、手术时间、切口类型、胆囊与周围脏器粘连,胆囊颈结石、Calot三角粘连、胆囊壁厚、合并糖尿病、手术室各区域布局、放置引流有关(均P＜0.05);多因素Logistic回归分析表明,高龄、急诊手术、胆囊与周围脏器粘连、Calot三角粘连和合并糖尿病是LC并发症的危险因素,而手术室各区域合理布局和放置引流是防止LC并发症的重要因素(均P＜0.05).结论:LC患者手术并发症的发生较常见,且受多种因素的影响.     

急诊普外科手术患者术后并发症的危险因素分析

目的探讨急诊普外科手术患者术中不良事件的发生与术后并发症的关系,同时分析其出现术后并发症的危险因素。方法回顾性分析南京医科大学第一附属医院2015年9月至2016年9月接受普外科手术的689例急诊患者临床资料。收集患者术前和术中相关临床指标与预后信息,分别行单因素和多因素分析各临床指标与术后并发症的相关性。结果 689例患者中,有165例(23.9%)在术后30 d内出现主要系统并发症。最常见的术后并发症为呼吸系统并发症(40.6%)。术后并发症的独立危险因素为年龄(每增加15岁,OR 1.880,95%CI 1.448~2.440)、ASA分级(每升高一级,OR 3.303,95%CI 2.303~4.736)、术中低血压持续时间20 min(OR 2.501,95%CI 1.387~4.510)、术中快速型心律失常(OR 2.173,95%CI 1.002~4.711)以及手术级别(每增加一级,OR1.814,95%CI 1.060~3.103)。结论急诊普外科手术患者术中低血压持续时间超过20 min以及发生快速型心律失常均是出现术后并发症的独立危险因素;在对急诊手术患者进行循环管理时,尽量将其术中收缩压的下降幅度控制在20%以内,维持血流动力学的稳定,以降低术后并发症的发生风险。     

老年患者嵌顿性腹股沟疝急诊手术预后影响因素的分析

目的探讨影响老年患者嵌顿性腹股沟疝急诊手术预后的因素。方法选取2014年2月至2015年2月80例老年嵌顿性腹股沟疝行急诊手术患者作为研究对象,分析患者的临床资料数据,对研究结果收集后进行统计学分析比较,观察患者肠切除和患者死亡率的相关影响因素。采用SPSS18.00软件进行统计学分析,年龄、嵌顿类型、慢性病、既往腹部手术史、术前嵌顿持续时间采用logistic回归进行数据分析。以P0.05表示差异具有统计学意义。结果既往腹部手术史(OR=1.692,P=0.001)、术前嵌顿持续时间大于24 h(OR=1.550,P=0.000)以及慢性疾病(OR=1.562,P=0.000)是肠切除手术的危险因素。患者的生存率与年龄(P=0.085)没有相关性,接受过肠切除手术和嵌顿持续时间超过24 h是影响患者生存的显著危险因素(P=0.001,P=0.000)。结论术前嵌顿疝持续时长超过24 h、腹部手术史及慢性疾病与肠切除相关。嵌顿持续时间、肠切除手术是影响老年患者嵌顿性腹股沟疝术后生存状况的重要影响因素。     

同种异体原位肝移植术后远期胆道并发症相关因素的分析

目的探讨同种异体原位肝移植术后远期胆道并发症发生的原因。方法回顾性分析2年施行的肝移植病例中,存活时间超过6个月的4 1例肝移植患者的临床资料。其中2 9例(A组)无远期胆道并发症,1 2例(B组)有远期胆道并发症。比较两组的一般情况(性别、年龄、原发疾病、术前肝功能等)、供体脑死亡到腹主动脉低温灌注开始的时间(一次热缺血,热缺血时间1)、冷保存时间、门静脉血流复通到肝动脉血流复通的时间(二次热缺血,热缺血时间2)、手术时间、术中出血量、术后肝动脉血栓形成的比例等。结果平均年龄,A组为(4 6.9±1 0.5)岁,B组为(5 3.7±7.4)岁。二次热缺血时间,A组为(6 3.3 8±2 2.9 7)m in,B组为(8 1.2 5±3 0.8 7)m in。术中出血量,A组为(3 8 1 7.2±1 4 0 2.3)mL,B组为(5 5 7 9.2±1 8 0 1.4)mL。以上3项指标两组差异有显著性;其他指标无统计学差异。供肝第一次热缺血时间超过5m in,同时冷缺血时间超过8 h的病例数,A组为1 2例(1 2/2 9),B组为6例(6/1 2),两组无统计学差异。结论第一次热缺血时间及冷保存时间的长短不影响手术后胆道并发症的发生;移植肝第二次热缺血时间延长可以增加术后远期胆道并发症的发生率,高龄患者更易发生胆道并发症。     

尿道下裂成形术后并发症的临床分析

Objectives To study and analyze the cauge,rate and treatment for complications of hypospadi - as repair operations.Methods In the past 3 years,there were 19 patients with complications of hypospedias repair for 117 cases single - stage urethmplasty.The ages were from 1.5 to 24 years old,the mean Was 4.6.The classifica - tions were glans of penis 10,body of penis 5,serious hypospedias 4,includingpenoscrota,scrotal andperineal.The lengths of new urethras were from 1.2 to 4.4 cm,the mean was 2.6 cm.Results The rate of complications was 15.9%for 1～3 years following survey.There were urethral fistulas 11 cases(57.9%),urethral strictures 4(21.1%),diverticulumsl(5.3%),withdrawal of meatus 1(5.3%),chordees 1(5.3%),seriouS abnomal apperance of penis 1 cases(5.3%).The rate of urethral fistulas was the first and urethral stricture the second,they were higher than other complications signiflcantly(P相似文献   

尿道下裂成形术后并发症的临床分析

Objectives To study and analyze the cauge,rate and treatment for complications of hypospadi - as repair operations.Methods In the past 3 years,there were 19 patients with complications of hypospedias repair for 117 cases single - stage urethmplasty.The ages were from 1.5 to 24 years old,the mean Was 4.6.The classifica - tions were glans of penis 10,body of penis 5,serious hypospedias 4,includingpenoscrota,scrotal andperineal.The lengths of new urethras were from 1.2 to 4.4 cm,the mean was 2.6 cm.Results The rate of complications was 15.9%for 1～3 years following survey.There were urethral fistulas 11 cases(57.9%),urethral strictures 4(21.1%),diverticulumsl(5.3%),withdrawal of meatus 1(5.3%),chordees 1(5.3%),seriouS abnomal apperance of penis 1 cases(5.3%).The rate of urethral fistulas was the first and urethral stricture the second,they were higher than other complications signiflcantly(P相似文献   

尿道下裂成形术后并发症的临床分析

Objectives To study and analyze the cauge,rate and treatment for complications of hypospadi - as repair operations.Methods In the past 3 years,there were 19 patients with complications of hypospedias repair for 117 cases single - stage urethmplasty.The ages were from 1.5 to 24 years old,the mean Was 4.6.The classifica - tions were glans of penis 10,body of penis 5,serious hypospedias 4,includingpenoscrota,scrotal andperineal.The lengths of new urethras were from 1.2 to 4.4 cm,the mean was 2.6 cm.Results The rate of complications was 15.9%for 1～3 years following survey.There were urethral fistulas 11 cases(57.9%),urethral strictures 4(21.1%),diverticulumsl(5.3%),withdrawal of meatus 1(5.3%),chordees 1(5.3%),seriouS abnomal apperance of penis 1 cases(5.3%).The rate of urethral fistulas was the first and urethral stricture the second,they were higher than other complications signiflcantly(P相似文献   

尿道下裂成形术后并发症的临床分析

Objectives To study and analyze the cauge,rate and treatment for complications of hypospadi - as repair operations.Methods In the past 3 years,there were 19 patients with complications of hypospedias repair for 117 cases single - stage urethmplasty.The ages were from 1.5 to 24 years old,the mean Was 4.6.The classifica - tions were glans of penis 10,body of penis 5,serious hypospedias 4,includingpenoscrota,scrotal andperineal.The lengths of new urethras were from 1.2 to 4.4 cm,the mean was 2.6 cm.Results The rate of complications was 15.9%for 1～3 years following survey.There were urethral fistulas 11 cases(57.9%),urethral strictures 4(21.1%),diverticulumsl(5.3%),withdrawal of meatus 1(5.3%),chordees 1(5.3%),seriouS abnomal apperance of penis 1 cases(5.3%).The rate of urethral fistulas was the first and urethral stricture the second,they were higher than other complications signiflcantly(P相似文献   

腹腔镜胰十二指肠切除术疗效与安全性的单中心回顾性分析

背景与目的:随着腹腔镜技术的发展与普及,腹腔镜胰十二指肠切除术(LPD)也逐渐在临床开展,但由于LPD手术难度大,其效果与安全性方面仍存在一定程度的不确定性.因此,本研究通过对笔者中心实施LPD及同期实施开放胰十二指肠切除术(OPD)患者的临床资料行回顾性分析,进一步评价LPD的近期疗效与安全性.方法:收集2019年2...     

尿道下裂成形术后并发症的临床分析

Objectives To study and analyze the cauge,rate and treatment for complications of hypospadi - as repair operations.Methods In the past 3 years,there were 19 patients with complications of hypospedias repair for 117 cases single - stage urethmplasty.The ages were from 1.5 to 24 years old,the mean Was 4.6.The classifica - tions were glans of penis 10,body of penis 5,serious hypospedias 4,includingpenoscrota,scrotal andperineal.The lengths of new urethras were from 1.2 to 4.4 cm,the mean was 2.6 cm.Results The rate of complications was 15.9%for 1～3 years following survey.There were urethral fistulas 11 cases(57.9%),urethral strictures 4(21.1%),diverticulumsl(5.3%),withdrawal of meatus 1(5.3%),chordees 1(5.3%),seriouS abnomal apperance of penis 1 cases(5.3%).The rate of urethral fistulas was the first and urethral stricture the second,they were higher than other complications signiflcantly(P相似文献   

尿道下裂成形术后并发症的临床分析

Objectives To study and analyze the cauge,rate and treatment for complications of hypospadi - as repair operations.Methods In the past 3 years,there were 19 patients with complications of hypospedias repair for 117 cases single - stage urethmplasty.The ages were from 1.5 to 24 years old,the mean Was 4.6.The classifica - tions were glans of penis 10,body of penis 5,serious hypospedias 4,includingpenoscrota,scrotal andperineal.The lengths of new urethras were from 1.2 to 4.4 cm,the mean was 2.6 cm.Results The rate of complications was 15.9%for 1～3 years following survey.There were urethral fistulas 11 cases(57.9%),urethral strictures 4(21.1%),diverticulumsl(5.3%),withdrawal of meatus 1(5.3%),chordees 1(5.3%),seriouS abnomal apperance of penis 1 cases(5.3%).The rate of urethral fistulas was the first and urethral stricture the second,they were higher than other complications signiflcantly(P相似文献   

尿道下裂成形术后并发症的临床分析

Objectives To study and analyze the cauge,rate and treatment for complications of hypospadi - as repair operations.Methods In the past 3 years,there were 19 patients with complications of hypospedias repair for 117 cases single - stage urethmplasty.The ages were from 1.5 to 24 years old,the mean Was 4.6.The classifica - tions were glans of penis 10,body of penis 5,serious hypospedias 4,includingpenoscrota,scrotal andperineal.The lengths of new urethras were from 1.2 to 4.4 cm,the mean was 2.6 cm.Results The rate of complications was 15.9%for 1～3 years following survey.There were urethral fistulas 11 cases(57.9%),urethral strictures 4(21.1%),diverticulumsl(5.3%),withdrawal of meatus 1(5.3%),chordees 1(5.3%),seriouS abnomal apperance of penis 1 cases(5.3%).The rate of urethral fistulas was the first and urethral stricture the second,they were higher than other complications signiflcantly(P相似文献   

尿道下裂成形术后并发症的临床分析

Objectives To study and analyze the cauge,rate and treatment for complications of hypospadi - as repair operations.Methods In the past 3 years,there were 19 patients with complications of hypospedias repair for 117 cases single - stage urethmplasty.The ages were from 1.5 to 24 years old,the mean Was 4.6.The classifica - tions were glans of penis 10,body of penis 5,serious hypospedias 4,includingpenoscrota,scrotal andperineal.The lengths of new urethras were from 1.2 to 4.4 cm,the mean was 2.6 cm.Results The rate of complications was 15.9%for 1～3 years following survey.There were urethral fistulas 11 cases(57.9%),urethral strictures 4(21.1%),diverticulumsl(5.3%),withdrawal of meatus 1(5.3%),chordees 1(5.3%),seriouS abnomal apperance of penis 1 cases(5.3%).The rate of urethral fistulas was the first and urethral stricture the second,they were higher than other complications signiflcantly(P相似文献