专题研究(Monographic Study)

腹腔镜胆囊切除术并发症发生的相关影响因素分析

Published at: 2016年第25卷第2期

陈智勇 1 , 陈文有 1 , 杨爱国 1
1 中国人民解放军第一七五医院 普通外科,福建 漳州 363000
通讯作者 文有 陈 Email: mgss17@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.02.010
基金:

摘要

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P<0.05);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P<0.05)。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。


Analysis of influential factors for complications associated with laparoscopic cholecystectomy

Abstract

Objective: To determine the risk factors for complications of laparoscopic cholecystectomy (LC). Methods: The clinical data of 312 patients undergoing LC from September 2012 to September 2014 were collected. The occurrence of complications and the related risk factors were analyzed. Results: Complications occurred in a total of 81 patients (25.96%), which included rupture of gallbladder in 22 cases (7.05%), abdominal hemorrhage in 28 cases (8.97%), injury of hepatic artery in 17 cases (5.45%) and biliary fistula in 14 cases (4.48%). Univariate analysis showed that adhesions in Calot’s triangle, anatomic variations, acute stage of disease, use of electrocautery in dissection of Calot’s triangle and gallbladder wall thickness (>5 mm) were related to the occurrence of complications of LC (all P<0.05); multivariate analysis identified that adhesions in Calot’s triangle (OR=3.466, 95% CI=1.432-8.389), regional anatomic variations (OR=1.988, 95% CI=1.237-3.194) and use of electrocautery in dissection of Calot’s triangle (OR=1.089, 95% CI=1.015-1.168) were independent risk factors for complications of LC (all P<0.05). Conclusion: Preoperative evaluation should be performed thoroughly to identify the risk factors in patients undergoing LC, and use of electrocautery in dissection of Calot’s triangle should be avoided, so as to reduce the occurrence of postoperative complications.


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引用

引用本文: 智勇 陈, 文有 陈, 爱国 杨. 腹腔镜胆囊切除术并发症发生的相关影响因素分析 [J]. 中国普通外科杂志, 2016, 25(2): 214-218.
Cite this article as: CHEN Zhiyong, CHEN Wenyou, YANG Aiguo . Analysis of influential factors for complications associated with laparoscopic cholecystectomy [J]. Chin J Gen Surg, 2016, 25(2): 214-218.