肝囊型包虫病胆瘘发生影响因素分析

Risk factors of biliary fistula in patients with cystic echinococcosis

目的探讨肝囊型包虫病胆瘘(CBF)发生的影响因素。方法回顾性分析2016年1月至2018年12月新疆维吾尔自治区人民医院收治的145例肝囊型包虫病患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男70例,女75例;平均年龄(41±18)岁。肝囊型包虫病CBF发生单因素分析采用t检验、秩和检验和χ^2检验。多因素Logistic回归分析筛选CBF发生的独立危险因素。结果本组患者CBF发生率为27.6%(40/145),其中腹部影像学检查发现12例,术中发现18例,术后发现10例。单因素分析显示,CBF发生与术前黄疸、胆管炎、囊肿数量、肝包虫病类型、手术方式(χ^2=4.56,6.58,7.86,5.67,6.58;P<0.05),ALP、GGT(Z=6.57,4.38;P<0.05),囊肿直径(t=4.78,P<0.05)相关。多因素分析显示,ALP>81 U/L、GGT>50 U/L、囊肿直径>8 cm是CBF发生的独立危险因素(OR=1.112,1.134,1.025;P<0.05)。结论术前ALP、GGT和囊肿直径是肝囊型包虫病发生CBF的预测因素。

Objective To investigate the risk factors of cystobiliary fistula(CBF)in patients with cystic echinococcosis.Methods Clinical data of 145 patients with cystic echinococcosis admitted to Xinjiang Uiger Municipal People's Hospital from January 2016 to December 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,70 patients were male and 75 female,aged(41±18)years old.Univariate analysis of the incidence of CBF in patients with cystic echinococcosis was performed by t test,rank sum test and Chisquare test.The independent risk factors for CBF were identified by multivariate Logistic regression analysis.Results The incidence of CBF in all patients was 27.6%(40/145).The CBF of 12 cases was found by abdominal imaging examination,18 cases was found during the operation and 10 cases after the operation.Univariate analysis demonstrated that the incidence of CBF was significantly correlated with preoperative jaundice,cholangitis,number of cysts,type of hepatic echinococcosis and surgical methods(χ2=4.56,6.58,7.86,5.67,6.58;P<0.05),ALP,GGT(Z=6.57,4.38;P<0.05),cyst diameter(t=4.78,P<0.05).Multivariate analysis showed that ALP>81 U/L,GGT>50 U/L and cyst diameter>8 cm were the independent risk factors for CBF(OR=1.112,1.134,1.025;P<0.05).Conclusions Preoperative ALP,GGT and cyst diameter are the risk factors for CBF in patients with cystic echinococcosis.