胆囊结石术后并发胆瘘的因素研究及预警性干预指导

Study on the risk factors for biliary fistula in patients after gallbladder stones and early warning intervention guidance

目的探讨胆囊结石术后并发胆瘘的危险因素并提出预警性干预指导。方法回顾性分析2018年6月—2022年6月在本院行胆囊结石术后的343例患者的临床资料,总结可能导致术后并发胆瘘的危险因素,对比发生者和未发生者可能影响因素的构成比,并进行Logistic回归分析。结果术后共有26例患者并发胆瘘,其中术后72小时内发生胆瘘14例,术后1周发生胆瘘9例,术后2周发生3例,发生率为7.58%;发生组开腹手术、胆囊炎症、胆管感染、术中强制分离结石、缝线型号>4、缝线结扎过紧、结石有残余、引流管放置不当、术后引流不通畅、手术医师工龄<3年、术后剧烈运动、缝线脱落构成比均明显高于未发生组(P<0.05),经Logistic回归分析可知,开腹手术、胆囊炎症、胆管感染、术中强制分离结石、缝线型号>4、缝线结扎过紧、结石有残余、引流管放置不当、术后引流不通畅、手术医师工龄<3年、术后剧烈运动、缝线脱落均是影响胆囊结石术后并发胆瘘的独立危险因素(OR=7.493、4.092、6.713、4.424、6.521、4.433、6.613、4.702、5.824、5.836、6.086、7.645,P<0.05)。结论开腹手术、胆囊炎症、胆管感染、术中强制分离结石、缝线型号>4、缝线结扎过紧、结石有残余、引流管放置不当、术后引流不通畅、手术医师工龄<3年、术后剧烈运动、缝线脱落均是胆囊结石术后并发胆瘘的独立危险因素,需加强防控。

Objective To explore the risk factors for biliary fistula in patients after gallbladder stones,and to put forward warning interventional suggestions.Methods The data of 343 patients who underwent cholecystolithiasis surgery in our hospital from June 2018 to June 2022 were retrospectively analyzed.The risk factors that may lead to biliary fistula after gallbladder stones were summarized.The composition ratio of influential factors between occurred and non occurred groups were compared,then Logistic regression analysis was carried out.Results A total of 26 patients had biliary fistula after operation,14 cases were occurred at 72 hours after operation,9 cases were occurred at 1 week after operation and 3 cases were occurred at 2 weeks after operation,the incidence was 7.58%.The proportion of open surgery,gallbladder inflammation,bile duct infection,forcible separation of the stone during operation,the typesuture bigger than 4,the suture ligation is too tight,stone residue,the drainage tube is not properly placed,the drainage is not clear after the operation,the length of service of operation doctor shorter than 3 years,strenuous exercise after the operation and the suture falls off were significantly higher than those in the non-occurrence group(P<0.05).Logistic regression analysis showed that open surgery,gallbladder inflammation,bile duct infection,forcible separation of the stone during operation,the suture type bigger than 4,the suture ligation is too tight,stone residue,the drainage tube is not properly placed,the drainage is not clear after the operation,the length of service of operation doctor shorter than 3 years,strenuous exercise after the operation and the suture falls off were independent risk factors affecting gallbladder fistula after cholecystolithiasis(OR=7.493,4.092,6.713,4.424,6.521,4.433,6.613,4.702,5.824,5.836,6.086,7.645,P<0.05).Conclusions The open surgery,gallbladder inflammation,bile duct infection,forcible separation of the stone during operation,the suture type bigger than 4,the suture ligation is too tight,stone residue,the drainage tube is not properly placed,the drainage is not clear after the operation,the length of service of operation doctor shorter than 3 years,strenuous exercise after the operation and the suture falls off were independent risk factors affecting gallbladder fistula after cholecystolithiasis,which need to be strengthened prevention and control.