肝门部胆管癌根治术后临床相关胆瘘的影响因素研究

Study on the Influencing Factors of Clinically Relevant Biliary Fistula After Radical Operation of Hilar Cholangiocarcinoma

目的 研究肝门部胆管癌根治术后临床相关胆瘘的影响因素。方法 回顾性选取87例HCCA患者,患者均接受肝门部胆管癌根治术治疗。收集患者一般资料,将B级、C级胆瘘患者纳入胆瘘组,A级及未发生胆瘘患者纳入无胆瘘组。结果 87例HCCA患者术后发生胆瘘25例,胆瘘发生率28.74%(25/87);其中A级、B级、C级胆瘘各有7例、11例、7例。胆瘘组术前胆管炎发生率、年龄、胆肠吻合口数量高于无胆瘘组,有统计学差异(P<0.05);2组在性别、Bismuth分型、ASA评分、胆管引流、血管重建、胰十二指肠切除、术中出血量、手术时间、PLT、AST、ALT等方面对比,无统计学差异(P>0.05);采用Logistic回归分析显示,术前胆管炎、年龄、胆肠吻合口数量为影响肝门部胆管癌根治术后临床相关胆瘘的独立危险因素(P<0.05且OR≥1)。结论 肝门部胆管癌根治术后临床相关胆瘘的影响因素主要包括术前胆管炎、年龄、胆肠吻合口数量,临床需重视,选择合适的术式,并加强对患者围手术期的管理,以降低胆瘘发生风险。

Objective To study the influencing factors of clinically related biliary fistula after radical resection of hilar cholangiocarcinoma.Methods 87 patients with HCCA were selected retrospectively.All patients received radical resection of hilar cholangiocarcinoma.Collect the general data of patients, and include the patients with grade B and grade C biliary fistula into the biliary fistula group, and the patients with grade A and without biliary fistula into the non-biliary fistula group.Results Postoperative biliary fistula occurred in 25 of 87 patients with HCCA.The incidence of biliary fistula was 28.74%(25/87);There were 7 cases, 11 cases and 7 cases of grade A,B and C biliary fistula respectively.The incidence of preoperative cholangitis, age and number of biliary and intestinal anastomoses in the biliary fistula group were significantly higher than those in the non-biliary fistula group(P);There was no statistical difference between the 2 groups in terms of gender, Bismuth classification, ASA score, biliary drainage, vascular reconstruction, pancreaticoduodenectomy, intraoperative bleeding, operation time, PLT,AST,ALT,etc.(P>0.05);Logistic regression analysis showed that preoperative cholangitis, age, number of biliary and intestinal anastomoses were independent risk factors for clinically related biliary fistula after radical resection of hilar cholangiocarcinoma(P<0.05 and OR ≥1).Conclusion The influencing factors of clinically related biliary fistula after radical resection of hilar cholangiocarcinoma mainly include preoperative cholangitis, age, number of biliary and intestinal anastomoses.Clinical attention should be paid to the selection of appropriate operation methods and the strengthening of perioperative management of patients to reduce the risk of biliary fistula.