老年急性胆囊炎患者腹腔镜胆囊切除术后胆管损伤的影响因素

Analysis of influencing factors of postoperative bile duct injury in senile acute cholecystitis patients with laparoscopic cholecystectomy

〔目的〕探讨老年急性胆囊炎患者腹腔镜胆囊切除术后胆管损伤的影响因素。〔方法〕采用回顾性分析法,收集2017年1月至2020年1月于某医院行腹腔镜胆囊切除术的74例老年急性胆囊炎患者临床资料,根据术后是否发生胆管损伤分为发生组(32例)、未发生组(42例)。仔细阅览74例患者病历资料,设计一般情况调查问卷,并将可能的影响因素纳入,经单因素与多因素分析找出老年急性胆囊炎患者腹腔镜胆囊切除术后胆管损伤的影响因素。〔结果〕经卡方检验单因素分析与非条件多项Logistic回归分析,检验结果显示,胆囊壁厚度>4 mm、胆囊三角解剖异常、医师临床经验少于100例均是老年急性胆囊炎患者腹腔镜胆囊切除术后胆管损伤的危险因素(OR>1,P<0.05)。〔结论〕胆囊三角解剖存在变异、医师手术经验少、胆囊壁厚度>4 mm是导致腹腔镜胆囊切除术后胆管损伤的危险因素,临床需重点关注并予以相应干预措施。

[Objective]To investigate the influencing factors of postoperative bile duct injury in senile acute cholecystitis patients with laparoscopic cholecystectomy.[Methods]The retrospective analysis was performed,and the clinical data of 74 senile acute cholecystitis patients with laparoscopic cholecystectomy in a hospital from January 2017 to January 2020 were collected.The patients were divided into occurrence group(32 cases) and non-occurrence group(42 cases) according to postoperative bile duct injury.After carefully reviewing the medical records of 74 patients,the general situation questionnaire was designed and the possible factors were included.The single-factor and multi-factor analysis was used to find out the influencing factors of bile duct injury after-laparoscopic cholecystectomy in senile patients with acute cholecystitis.[Results] Chi-square test single-factor analysis and unconditional multiple Logistic regression analysis showed that the gallbladder wall thickness,anatomy of calot’s triangle,and clinical experience of the physician were the risk factors for bile duct injury after-laparoscopic cholecystectomy in senile patients with acute cholecystitis(OR>1,P<0.05).[Conclusion] Variation of anatomy of calot’s triangle,little surgical experience of physician,and gallbladder wall thickness> 4 mm are the risk factors for bile duct injury after laparoscopic cholecystectomy,and clinical attention needs to be focused on and corresponding intervention measures should be taken.It is necessary to pay attention to these factors and give corresponding intervention measures.