肝胆管结石肝切除术后结石残留的相关危险因素分析

Analysis of Risk Factors Associated with Postoperative Stone Residue of Patients with Hepatolithiasis after Hepatectomy

目的探讨肝胆管结石患者行肝切除手术后发生结石残留的危险因素。方法回顾性分析2015年1月至2019年12月接受肝切除手术治疗的肝胆管结石患者223例,术后发生结石残留42例(结石残留组),未发生结石残留181例(无结石残留组),对两组各危险因素进行单因素分析和多因素非条件Logistic回归分析。结果肝胆管结石肝切除术后结石残留发生率18.8%(42/223),单因素分析结果显示,肝切除术后结石残留与急性胆管炎、II型肝胆管结石病、肝门胆管狭窄、手术方式和肝切除范围有关(P<0.05);多因素Logistic回归分析显示,肝胆管结石肝切除术后结石残留的主要危险因素是II型肝胆管结石病、肝门胆管狭窄和肝切除范围(OR值分别为3.947、4.203、3.573,P<0.05)。结论肝胆管结石病肝切除术后结石残留的影响因素较多,其中肝胆管结石病分型、肝门胆管狭窄和肝切除范围可能是造成结石残留的独立危险因素,术前综合评估这些因素对预防术后结石残留有一定指导意义。

Objective To explore the risk factors of stone residue after hepatectomy in patients with hepatolithiasis.Methods Retrospective analysis of 223 hepatolithiasis patients undergoing hepatectomy from January 2015 to December 2019,including 42 cases with stones residual postoperative(residual stones group),and 181 cases without stones residual postoperative(No residual stone group).A single factor analysis and multivariate unconditional logistic regression analysis were carried out on each risk factor of the two groups.Results The incidence of stone residue after hepatectomy was 18.8%(42/223).The results of univariate analysis showed that stone residue after hepatectomy was related to acute cholangitis,classification of hepatolithiasis,hilar bile duct stricture,operational manner,and scope of hepatectomy(all P<0.05).Multivariate logistic regression analysis revealed that classification of hepatolithiasis,hilar bile duct stricture,and scope of hepatectomy(OR values were3.947,4.203,3.573,respectively,P<0.05)were independent risk factors for postoperative stone residue after hepatectomy.Conclusion There are multiple factors that affect the postoperative stone residue of hepatolithiasis patients after hepatectomy,among which classification of hepatolithiasis,hilar bile duct stricture,and scope of hepatectomy may be independent risk factors for residue.Integrated evaluation of these factors before operation has certain directive significance in preventing postoperative stone residue.