胆囊结石合并胆总管结石行腹腔镜胆总管探查一期缝合术后发生胆道并发症的影响因素

Influence factors of biliary complications after laparoscopic common bile duct exploration and primary suture in patients with cholecysto-choledocholithiasis

目的:分析胆囊结石合并胆总管结石(CLL)患者行腹腔镜胆总管探查(LCBDE)一期缝合术后发生胆道并发症的影响因素。方法:前瞻性纳入2020年1月至2022年1月接受手术治疗的80例CLL患者作为研究对象,根据术后胆道并发症情况进行分组,分为发生组与未发生组。统计患者一般临床资料及检查结果,分析CLL患者LCBDE一期缝合术后并发症发生的影响因素。结果:80例患者中,术后发生胆漏9例、胆管狭窄2例,并发症发生率为13.75%;两组合并糖尿病情况、胆总管直径、Calot三角粘连情况、手术时间差异有统计学意义(P<0.05);发生组血清白蛋白低于未发生组,差异有统计学意义(P<0.05)。Logistic回归分析显示,合并糖尿病、胆总管直径<1 cm、Calot三角粘连、手术时间长、血清白蛋白低表达是增加CLL患者LCBDE一期缝合术后并发症发生风险的影响因素。结论:糖尿病、胆总管直径<1 cm、Calot三角粘连、手术时间长、血清白蛋白低表达等因素可增加CLL患者LCBDE一期缝合术后并发症的发生风险。

Objective:To analyze the influencing factors of biliary complications after laparoscopic common bile duct exploration(LCBDE)with primary suture in patients with cholecysto-choledocholithiasis(CLL).Methods:Between Jan.2020 and Jan.2022,80 patients with CLL who underwent surgical treatment were prospectively enrolled.All patients were treated with LCBDE and primary suture.Patients were divided into the occurrence and the non-occurrence groups according to the occurrence of postoperative biliary complications.The general clinical data and examination results of patients were counted and the influencing factors of complications after LCBDE and primary suture in CLL patients were analyzed.Results:In 80 CLL patients,postoperative bile leakage occurred in 9 patients,and bile duct stenosis occurred in 2 patients,with an incidence of 13.75%.There were statistically significant differences between the two groups in the proportion of patients with concomitant diabetes,common bile duct diameter,Calot's triangle adhesion,and operative time(P<0.05).The serum albumin(ALB)in the occurrence group was lower than that in the non-occurrence group,and the difference was statistically significant(P<0.05).Logistic regression analysis showed that diabetes mellitus,common bile duct diameter<1 cm,Calot triangle adhesion,long operation time and low serum ALB expression were the influencing factors to increase the risk of biliary complications after LCBDE and primary suture in CLL patients(P<0.05).Conclusions:Diabetes mellitus,common bile duct diameter<1 cm,Calot triangle adhesion,long operation time and low serum ALB expression can increase the risk of biliary complications after LCBDE and primary suture in CLL patients.