腹腔镜胆总管探查一期缝合术后胆瘘及胆总管狭窄的危险因素分析

目的 探讨腹腔镜胆总管探查（LCBDE）及一期缝合术后发生胆瘘及胆总管狭窄的临床危险因素。方法 收集自2017年1月至2019年6月湖州市中心医院收治的92例行LCBDE胆总管一期缝合术患者的临床资料,行回顾性对列研究及多因素回归分析。结果 全组患者术后胆瘘及胆总管狭窄发生率分别为11.9%（11/92）和18.5%（17/92）。合并糖尿病、胆总管直径＜1 cm、由胆总管一期缝合手术操作例数＜30例的主刀医师行手术治疗的患者术后胆瘘及胆总管狭窄的发生率明显升高（P＜0.05）。多因素回归分析发现,上述三个因素是LCBDE胆总管一期缝合术后胆瘘发生的独立危险因素[合并糖尿病：OR（95%CI）4.782（1.176～19.439）,P=0.029;胆总管直径＜1 cm：OR（95%CI）5.743（1.535～21.481）,P=0.009;胆总管一期缝合手术操作例数＜30例：OR（95%CI）4.693（1.251～17.612）,P=0.022],同时上述三个因素也是术后胆总管狭窄发生的独立危险因素[合并糖尿病：OR（95%CI）3.455（1.147～10.406）,P=0.028;胆总管直径＜1 cm：OR（95%CI）4.667（1.500～14.518）,P=0.008;胆总管一期缝合手术操作例数＜30：OR（95%CI）3.094（1.049～9.121）,P=0.041]。结论 合并糖尿病、胆总管直径＜1 cm、主刀医师经验不足（操作例数＜30例）是LCBDE胆总管一期缝合术后发生胆瘘及胆总管狭窄的独立危险因素。对存在糖尿病或胆总管直径＜1 cm的患者应避免行胆总管一期缝合术;在学习曲线内的主刀医师应采取合理的胆总管一期缝合方式以避免术后胆瘘及胆总管狭窄的发生。

Risk factors for bile leakage and common bile duct stricture after laparoscopic common bile duct exploration and primary closure

Objective To investigate the risk factors for bile leakage and common bile duct(CBD)stricture after laparoscopic common bile duct exploration(LCBDE)and primary closure.Methods A retrospective study was performed in 92 patients who underwent LCBDE and primary closure between Jan.2017 and Jun.2019 in Huzhou Central Hospital.Risk factors for bile leakage and common bile duct stricture were identified by Logistic regression analysis.Results Among 92 patients,bile leakage occurred in 11 patients(11.9%)and common bile duct stricture occurred in 17 patients(18.5%).Postoperative bile leakage and common bile duct stricture more frequently occurred in patients with diabetes mellitus,diameter of CBD<1 cm and those managed by inexperienced surgeons(during learning curve:initial 30 cases)(P<0.05).Logistic regression analysis identified that these three features are risk factors for occurrence of bile leakage[diabetes mellitus:OR(95%CI)4.782(1.176~19.439),P=0.029;diameter of CBD<1 cm:OR(95%CI)5.743(1.535~21.481),P=0.009;inexperienced surgeon(initial 30 cases):OR(95%CI)4.693(1.251~17.612),P=0.022]and also for common bile duct stricture[diabetes mellitus:OR(95%CI)3.455(1.147~10.406),P=0.028;diameter of CBD<1 cm:OR(95%CI)4.667(1.500~14.518),P=0.008;inexperienced surgeon(initial 30 cases):OR(95%CI)3.094(1.049~9.121),P=0.041].Conclusion Diabetes mellitus,diameter of CBD<1 cm and inexperienced surgeon are the high risk factors for bile leakage and common bile duct stricture after LCBDE and primary closure.