高位胆道系统恶性肿瘤根治性术后并发症的危险因素分析

Risk factors for postoperative complication after radical surgery of biliary malignancy

目的探讨高位胆道系统恶性肿瘤患者行根治性手术后发生并发症的危险因素。方法回顾性分析2013年9月～2015年12月间45例行根治性手术的高位胆道系统恶性肿瘤患者，手术均由同一团队实施。收集患者的临床资料，根据术后并发症的严重程度分级和是否为感染并发症进行分类，以分析影响高位胆道系统恶性肿瘤根治性术后并发症的危险因素。结果全组45例高位胆道系统恶性肿瘤患者行根治性手术后无在院死亡病例，术后出现严重手术并发症10例（22％），出现感染相关并发症和胆漏分别为25例（56％）、13例（29％）。经多因素分析证实，术后第一天总胆汁酸水平是影响高位胆道系统恶性肿瘤根治性手术后发生严重并发症的独立危险因素（OR=1．170，95％CI=1．028-1．331，P=0．02）；以所有患者为对象，诊断术后严重并发症的术后第一天血清TBA最佳阳性参考值为6．6μmol/L，诊断灵敏度、特异度分别为0．80、0．83。术前胆汁外引流是患者术后发生感染相关并发症的独立危险因素（OR=5．091，95％CI：1．319～19．649，P=0．02）。结论术后第一天血清TBA水平是高位胆道系统恶性肿瘤患者根治性手术后发生严重并发症的独立危险因素，其诊断的最佳参考值为6．6μmol／L。而术后发生感染相关并发症的独立危险因素是术前引流减黄。

Objective To determine the risk factors for postoperative complication after radical surgery of biliary malignancy （hilar cholangiocarcinoma, gallbladder cancer and intrahepatic cholangiocarcinoma）. Methods The clinical data of 45 biliary malig- nancy patients undergoing radical surgical treatment from September 2013 to December 2015 were retrospectively analyzed. All opera- tions were performed by the same surgical team. Uni- and multivariate logistic regression analysis was used to identify independent risk factors for major complications and infectious after surgery. Results Of the total of 45 biliary malignancy patients included in this study, there were no cases of in-hospital mortality after surgical treatment, and 10 （22%） patients developed major complication. In- fectious was the most frequent complication found in 25 （56%） patients, followed by bile leakage in 13 （29%）. Multivariate analysis identified a single independent risk factor for postoperative major complications after radical surgery, namely, total bile acid concentra- tion in serum on postoperative day 1 （OR = 1. 170, 95% CI = 1. 028 -1. 331, P =0. 02）. The cut-off value of serum total bile acid on postoperative day 1 was determined for postoperative major complications using the receiver operating characteristic curve analysis, and it was 6. 6 μmol/L with the sensitivity and specificity of 80% and 83% , respectively. Moreover, preoperative biliary drainage was the only independent risk factor of infectious complication in the postoperative course （ OR = 5.091,95% CI = 1. 319 - 19. 649, P = 0. 02）. Conclusion Serum total bile acid on postoperative day 1 was the only independent risk factor for postoperative major compli- cations after radical surgery of biliary malignancy, and the cut-off value was 6. 6 μmol/L. While preoperative biliary drainage increases the incidence of infectious complications.