经腹腔镜逆行胆囊切除术治疗复杂胆囊结石术后并发症的危险因素分析

Analysis of Risk Factors for Postoperative Complications of Laparoscopic Retrograde Cholecystectomy for Complex Gallbladder Stones

目的:探究经腹腔镜逆行胆囊切除术(LRC)治疗复杂胆囊结石(CGS)术后并发症的危险因素。方法:选择2019年3月—2021年3月我院收治的237例行LRC治疗的CGS患者作为研究对象,根据术后并发症发生情况分为无并发症组(220例)和并发症组(17例)。比较两组患者的一般资料;采用单因素及多因素Logisitic回归分析影响患者术后并发症发生的危险因素;构建风险评分模型,并评价其预测价值。结果:本研究中有17例CGS患者行LRC治疗后出现并发症,发生率为7.17%(17/237),包括胆管损伤3例,胆囊管过长3例,结石4例,胆漏7例;糖尿病、胆囊壁厚度>5 mm、胆囊颈部结石、周围脏器粘连、Calot三角粘连、急诊手术均是影响CGS患者行LRC后并发症发生的危险因素(P<0.05);将上述危险因素纳入风险评分模型,分别赋予19、35、42、31、38、27分的权重,将总分≤69分定义为中危组,69~152分定义为高危组,>152分定义为极高危组,模型预测的区分度和校准度较好。结论:分析影响CGS患者LRC后并发症发生的危险因素,有利于临床上早期识别高危人群,对降低患者术后并发症发生率、改善患者预后有重要意义。

Objective To explore the risk factors of complications after laparoscopic retrograde cholecystectomy(LRC)for the treatment of complex gallbladder stones(CGS)and provide reference value for the identification of clinical risk factors.Methods The 237 CGS patients treated with LRC who were admitted to our hospital from March 2019 to March 2021 were selected as the research objects.According to the occurrence of postoperative complications,the patients were divided into uncomplicated group(220 cases)and complication group(17 cases).The general data of the two groups of patients were compared.The single-factor and multi-factor Logisitic regression analyzed the factors affecting the occurrence of postoperative complications in patients.A risk scoring model was constructed and its predictive value was evaluated.Results Postoperative complications included 3 cases of bile duct injury,3 cases of cystic duct excessive length,4 cases of calculus and 7 cases of bile leakage.The complication rate was 7.17%(17/237).The diabetes,gallbladder wall thickness>5 mm,gallbladder neck stones,adhesions of surrounding organs,Calot triangle adhesions and emergency surgery are all risk factors that affect the occurrence of complications after LRC in CGS patients(P<0.05).The above risk factors were included in the risk score.The model assigns weights of 19,35,42,31,38 and 27 points respectively.The total scores≤69 points are defined as the intermediate risk group,>69 points and≤152 points are defined as the high-risk group,and>152 points are defined as the extremely high-risk group.The model predicts better discrimination and calibration.Conclusion Analyzing the risk factors of complications after LRC in CGS patients and constructing a risk scoring model are conducive to early clinical identification of high-risk groups,which is of great significance for reducing the incidence of postoperative complications and improving the prognosis of patients.