经皮肝穿刺胆管造瘘电子胆道镜取石术治疗肝内胆管结石患者并发症发生及其影响因素分析

Influencing factors ofpost-operational complications in patients with intrahepatic stone after percutaneous transhepatic cholangioscopic lithotomy

目的分析经皮肝穿刺胆管造瘘电子胆道镜取石术(PTCSL)治疗肝内胆管结石(IHS)患者发生术后并发症的影响因素。方法2015年5月~2019年5月我院消化内科就诊的115例IHS患者,其中60例接受PTCSL治疗,55例接受开腹手术。采用Logistic多因素回归分析影响术后并发症发生的因素。结果在两组,均顺利完成手术,取净结石;PTCSL组术后并发症发生率为21.7%,显著低于开腹组的49.1%(P<0.05),其中PTCSL组发生1例,开腹组发生4例下肢深静脉血栓,均经彩色多普勒超声检查早期发现,积极采取抗凝治疗后好转;术前白蛋白水平低、术中出血、有胆道手术史、术后发生胆汁多重耐药菌感染是影响PTCSL组患者发生并发症的因素(P<0.05);经多因素分析,术前白蛋白水平低【OR(95%CI)为0.5(0.3~0.9)】、术中出血【OR(95%CI)为2(1.4~3)】、胆道手术史【OR(95%CI)为1.9(1.3~2.7)】、术后胆汁多重耐药菌感染【OR(95%CI)为2.2(1.2~4.5)】是PTCSL组患者发生并发症的独立危险因素(P<0.05)。结论与常规开腹取石术相比,PTCSL可大大减少IHS患者术后并发症发生率,值得深入研究。

Objective The aim of this study was to analyze the influencing factors of post-operational complications in patients with intrahepatic stone(IHS)after percutaneous transhepatic cholangioscopic lithotomy(PTCSL).Methods 115 patients with IHS were admitted to the Department of Digestive Diseases in our hospital between May 2015 and May 2019,and 60 received PTCSL and 55 received open operation.The factors impacting the post-operational complications were retrospectively evaluated by Logistic analysis.Results The total successful operation were carried out in our series,and the stones were pull out in the two groups;the incidence of postoperative complications in the PTCSL group was 21.7%,significantly lower than that in the laparotomy group(49.1%,P<0.05),of which,one case of lower limb deep vein thrombosis occurred in the PTCSL group,and four cases in open laparotomy group,all beening found early by color Doppler ultrasonography and improved after active anticoagulant therapy;low serum albumin level before operation,bleeding during operation,biliary tract operation history and bile multi-drug resistant bacteria infection after operation were the factors affecting complications in PTCSL group(P<0.05),and the Logistic analysis showed that low pre-operative serum albumin level[OR(95%CI):0.5(0.3-0.9)],hemorrhage during operation[OR(95%CI):2(1.4-3)],biliary tract surgery history[OR(95%CI):9(1.3-2.7)],and bile multidrug-resistant bacteria infection[OR(95%CI):2.2(1.2-4.5)]were the independent risk factors for complications in the PTCSL group(P<0.05).Conclusion Compared with conventional laparotomy,PTCSL could greatly reduce the incidence of post-operational complications,which worth further investigation.