老年胆总管结石术后胆漏风险预测模型的建立

Establishment of risk prediction model for bile leakage in elderly patients with common bile duct stones

目的构建老年胆总管结石手术患者发生胆漏的风险预测模型.方法回顾性分析2013年1月至2018年12月间我院收治的319例老年胆总管结石患者的资料.根据是否发生胆漏将患者分为病例组(n=24)和对照组(n=295).结合性别、年龄、营养状况、高血压、糖尿病、胆囊结石、化脓性胆管炎、HBV感染病史、术前白细胞、术前肝功能指标、手术方式、手术时间等12项因素进行单因素分析及logistic回归分析.结果单因素分析的结果显示:年龄、营养状况、糖尿病、化脓性胆管炎、手术方式等5个因素与发生胆漏有关(P<0.05).logistic回归分析的结果显示:营养状况(OR=7.705,95%CI:2.382~24.923,P=0.001),糖尿病(OR=6.583,95%CI:2.066~20.978,P=0.001),化脓性胆管炎(OR=7.646,95%CI:2.146~27.245,P=0.002)是老年胆总管结石患者发生胆漏的独立危险因素.结论营养状况,糖尿病,化脓性胆管炎是老年胆总管结石患者术后发生胆漏的独立危险因素,在临床上应加以关注,以期减少胆漏的发生率.

Objective To establish a risk prediction model for bile leakage in elderly patients with common bile duct stones.Methods A total of 319 cases of elderly patients with common bile duct stones were analyzed retrospectively from January 2014 to December 2018 in our hospital.Patients were divided into case group(n=24)and control group(n=295)according to whether bile leakage occurred.Univariate analysis and logistic regression analysis were performed based on 12 factors,including gender,age,nutritional status,hypertension,diabetes,cholecystolithiasis,suppurative cholangitis,history of HBV infection,preoperative leukocyte count,preoperative liver function index,surgical approach,operation time.Results The results of univariate analysis showed that age,nutritional status,diabetes,suppurative cholangitis,surgical approach were associated with bile leakage(P<0.05).Logistic regression analysis showed that nutritional status(OR=7.705,95%CI:2.382~24.923,P=0.001),diabetes(OR=6.583,95%CI:2.066~20.978,P=0.001)and suppurative cholangitis(OR=7.646,95%CI:2.146~27.245,P=0.002)were the independent risk factors for bile leakage in elderly patients with common bile duct stones.The area under the model ROC curve was 0.922,and the regression model was reliable.Conclusion Nutritional status,diabetes and suppurative cholangitis were the independent risk factors for bile leakage in elderly patients with common bile duct stones.More attention should be paid to these factors in order to reduce the incidence of bile leakage.