肝胆外科患者术后并发胆漏危险因素分析及防治策略

Risk factors analysis and prevention strategies of postoperative bile leakage in patients with hepatobiliary surgery

目的探讨肝胆外科患者术后并发胆漏的危险因素,为临床治疗制定防治策略。方法选取2019年2月至2020年1月在某院普外科行肝胆外科手术的330例患者纳入本研究,按是否发生术后胆漏分为胆漏组(34例)及非胆漏组(296例),入选病例进行资料收集,并分析危险因素;将术后并发胆漏的34例患者按治疗方案分为非手术治疗组(20例)及手术治疗组(14例),比较两组疗效。结果肝胆外科术后胆漏发生率10.3%。单因素分析显示,手术方式、是否为初次手术、术者经验、手术类型、术前胆红素、合并胆管炎、合并胆囊结石与术后并发胆漏具有相关性(P<0.05);多因素Logistics回归分析显示,肝胆外科患者术后并发胆漏的危险因素为:腹腔镜手术、急诊手术、非初次手术、合并胆囊结石、合并胆管炎、术前胆红素>17.1μmol/L(P<0.05);非手术治疗组总有效率为90.00%,高于手术治疗组57.14%的总有效率(P<0.05)。结论腹腔镜手术、急诊手术、非初次手术、患者合并胆囊结石或胆管炎、术前胆红素水平过高为肝胆外科患者术后并发胆漏的危险因素;在防治策略中,应首先选择非手术治疗,并监测患者情况,必要时行手术干预。

Objective To explore the risk factors of postoperative bile leakage in patients with hepatobiliary surgery,and to develop prevention and treatment strategies for clinical treatment.Methods 330 patients who underwent hepatobiliary surgery in general surgery department of a certain hospital from February 2019 to January 2020 were included in this study.According to the incidence of postoperative bile leakage they were divided into bile leakage group(34 cases)and non-bile leakage group(296 cases).Data were collected and risk factors were analyzed.The 34 patients with postoperative bile leakage were divided into non-surgical treatment group(20 cases)and surgical treatment group(14 cases)according to the treatment scheme,and the clinical efficacy of the two groups was compared.Results The incidence of bile leakage after hepatobiliary surgery was 10.3%.Univariate analysis showed that the surgical method,whether it was the first operation,the experience of the surgeon,the type of operation,preoperative bilirubin,combined cholangitis,complicated gallstone were correlated with postoperative bile leakage(P<0.05).Multi-factor Logistics regression analysis showed that the risk factors for postoperative bile leakage in patients with hepatobiliary surgery were as follows:laparoscopic surgery,emergency surgery non-primary surgery,complicated gallstone,combined cholangitis,and preoperative bilirubin>17.1 umol/L(P<0.05).The total effective rate of the non-surgical treatment group was 90.00%,higher than 57.14%of the surgical treatment group(P<0.05).Conclusion Laparoscopic surgery,emergency surgery non-primary surgery,complicated gallstone,combined cholangitis,and high preoperative bilirubin level are risk factors for bile leakage after hepatobiliary surgery.In the prevention and treatment strategy,non-surgical treatment should be selected first,the condition of patients should be monitored,and surgical intervention should be carried out when necessary.