老年患者腹腔镜胆囊切除术并发症发生的相关危险因素分析

Correlated risk factors analysis of the complications of laparoscopic cholecystectomy in aged patients

目的:探讨老年患者腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)并发症发生情况及其相关危险因素,为LC并发症的防治提供可借鉴依据。方法:收集2013年4月至2016年4月783例行LC的老年患者的临床资料,分析并发症情况,并采用单因素及多因素分析的方法筛选并发症发生的相关危险因素。结果:并发症总发生率为4.47%(35/783),单因素回归分析结果显示,病程、专科手术经验、手术时间、胆囊壁厚度、胆囊与周围粘连、Calot三角粘连、胆囊颈结石、解剖变异、放置引流、合并基础疾病等10个因素与并发症密切相关。多因素分析表明,影响并发症发生的因素包括专科手术经验(OR=2.954)、胆囊壁厚度(OR=2.496)、胆囊与周围粘连(OR=3.286)、Calot三角粘连(OR=4.212)、放置引流(OR=0.321)、合并基础疾病(OR=4.532)。结论:老年患者行LC的并发症发生率仍较高,手术并发症发生的影响因素较多,临床应提高防范意识,采取针对性的预防措施,以降低并发症发生率,改善患者预后。

Objective： To investigate the risk factors of complications of laparoscopic cholecystectomy in aged patients, and pro- vide basis for preventing and treating complications of laparoscopic cholecystectomy. Methods ： Clinical data of 783 patients who under- went laparoscopic cholecystectomy were collected from Apr. 2013 to Apr. 2016 in the general surgical department of Fenghua People~ Hospital. The distribution of complications of laparoscopic cholecystectomy were analyzed, and the related risk factors of complications were screened by the univariate analysis and multivariate analysis. Results：The total incidence of complications of laparoscopic chole- cystectomy was 4.47% （35/783）. Theresults of single factor regression analysis showed that the course of disease, the experiences of specialized operation, operation time, the thickness of gallbladder wall,local adhesions of gallbladder, Calot triangle adhesions, calculus of gallbladder neck, anatomic variation, drainage and comorbidities were correlated to the occurrence of complications. The outcomes of muhiple factors regression analysis showed that the significant risk factors of complications of laparoscopic cholecystectomy included ex- periences of specialized operation （OR = 2. 954）, the thickness of gallbladder wall （OR = 2. 496）, local adhesions of gallbladder （OR = 3. 286）, Calot triangle adhesions （ OR = 4. 212）, drainage （ OR = 0. 321 ） and comorbidities （ OR = 4. 532）. Conclusions ： The com- plication incidence of laparoscopic cholecystectomy is still higher in aged patients, and there are many risk factors of the complications. The enhancement of precaution consciousness and the application of specific prevention measures will reduce the incidence of complica- tions and improve the prognosis of patients.