腹腔镜胆囊切除术治疗胆囊结石后的并发症情况及其危险因素

Complications and risk factors after laparoscopic cholecystectomy for cholecystolithiasis

目的分析腹腔镜胆囊切除术治疗胆囊结石后的并发症情况及其危险因素。方法回顾性分析我院2015年6月至2017年12月我院398例实施腹腔镜胆囊切除术治疗的胆囊结石患者的临床资料,其中16例发生并发症,382例无并发症。对腹腔镜胆囊切除术治疗胆囊结石后并发症的危险因素进行单因素和多因素分析。结果我院398例胆囊结石患者中发生并发症者16例,并发症发生率为4.02%。单因素分析结果显示,Calot三角黏连、手术时机、胆囊壁厚度、局部解剖变异与腹腔镜胆囊切除术治疗胆囊结石后并发症的发生有关(P<0.05);多因素分析结果显示,Calot三角黏连(OR=3.882)、胆囊壁厚度≥5 mm(OR=3.379)、急诊手术(OR=2.065)是引起腹腔镜胆囊切除术治疗胆囊结石后并发症发生的独立危险因素(P<0.05)。结论Calot三角黏连、胆囊壁厚度≥5 mm、急诊手术是引起腹腔镜胆囊切除术治疗胆囊结石后并发症发生的独立危险因素,术前应及时了解患者存在的危险因素,采取相应的预防措施。

Objective To analyze the complications and risk factors of laparoscopic cholecystectomy in the treatment of cholecystolithiasis. Methods The clinical data of 398 cases of patients with cholecystolithiasis performed laparoscopic cholecystectomy from June 2015 to December 2017 in our hospital was retrospectively analyzed. There were 16 cases with complications and 382 cases without complications. The risk factors of complications after laparoscopic cholecystectomy for cholecystolithiasis were analyzed by single factor and multivariate analysis. Results There were 16 cases of patients with complications in 398 cases of patients, the incidence of complications was 4.02%. Single factor analysis showed that the Calot＇s triangle adhesion, operative timing, gallbladder wall thickness and local anatomical variation were related to the incidence of complications after laparoscopic cholecystectomy（P〈0.05）. Multivariate analysis showed that the Calot triangle adhesions（OR =3.882）, gallbladder wall thickness ≥5 mm（OR =3.379）, emergency surgery（OR =2.065） were independent risk factors for the complications of laparoscopic cholecystectomy in the treatment of cholecystolithiasis（P〈 0.05）.Conclusion Calot triangle adhesions, gallbladder wall thickness ≥5 mm, emergency surgery are independent risk factors of complications after laparoscopic cholecystectomy for cholecystolithiasis, it should be aware of the risk factors in patients before surgery and take appropriate preventive measures.