腹腔镜胆道探查手术不良转归的预测指标

A study of the predictors of poor outcomes following laparoscopic bile duct exploration

目的:研究腹腔镜胆道探查患者术前疾病指标与手术不良转归的相关性。方法:收集218例腹腔镜胆道探查患者的术前资料,采用多变量分析定义三个手术不良转归:中转开放手术,术后发生并发症,术后住院时间延长。结果:患者血清胆红素水平增高与中转开放手术有关[OR=1.01(CI=1.00-1.01),P=0.01]。66.5%的患者无任何术后并发症,16%的患者有轻度ClavienⅠ级并发症,1例死亡;年龄越高,发生ClavienⅡ～Ⅴ级并发症的几率越高[OR=1.03(CI=1.01-1.05),P=0.02]。术前胆总管直径增粗[OR=1.16(CI=1.08-1.25),P<0.001]、既往上腹部手术史[OR=4.89(CI=1.10-21.74),P=0.04]及血清胆红素值增高[OR=1.04(CI=1.01-1.88),P=0.02]是术后住院时间延长的预测指标。结论:腹腔镜胆道探查手术是安全的,但高龄、黄疸、胆总管直径增粗及既往手术史可增加手术风险,此类患者应考虑其他治疗方法,以获得更好的预后。

Objective：To investigate the correlation between the preoperative disease factors and poor outcomes following laparoscopic bile duct exploration. Methods：The clinical data of 218 patients who underwent laparoscopic bile duct exploration was collected and reviewed, and a multivariate analysis was performed to identify three adverse outcomes：conversion to open operation, postoperative complication and prolonged hospital stay. Results：The elevated levels of serum bilirubin was correlated to conversion to open surgery [ OR = 1.01 （ CI = 1.00-1.01 ）, P = 0.01 ]. No postoperative complications were experienced by 66.5 % patients and 16% had a minor Clavien grade I complication. One case died. Clavien grade Ⅱ～Ⅴ complications occurred more frequently in those of increasing age [ OR = 1.03 （ CI = 1.01-1.05 ） ,P = 0.02 ]. The predictors of prolonged postoperative hospital stay included the enlargement of common bile duct diameter [ OR = 1. 16 （ CI = 1.08-1.25 ）, P 〈 0. 001 ], previous upper abdominal surgery [ OR = 4.89 （ CI = 1. 10-21.74 ）, P = 0.04 ], and elevated serum bilirubin [ OR = 1.04 （ CI = 1.01-1.88 ）, P = 0.02 ]. Conclusions ： Laparoscopic exploration of the bile duct is safe, but operative risks increase in patients with advanced age, jaundice, enlarged diameter of common bile duct and past medical history. Alternative therapies should be taken to acquire better prognosis for these patients.