三镜联合胆总管切开取石一期缝合治疗胆总管结石术后发生胆漏的危险因素分析及防治对策探讨

Risk factors and prevention strategies of bile leakage in patients with common bile duct stones after choledochoscope and duodenoscope combined with Laparoscopic choledochal exploration of stone calculi for primary suture

目的探讨三镜联合胆总管切开取石一期缝合治疗胆总管结石(CBDS)术后发生胆漏的危险因素。方法2019年1月~2022年10月行三镜联合胆总管切开取石一期缝合术的CBDS病人176例,分析病人的临床资料和术后胆漏的发生情况,采用多因素回归分析三镜联合胆总管切开取石一期缝合术后发生胆漏的危险因素。结果176例病人中,29例术后发生胆漏,发生率为16.48%;多因素Logistic分析表明,血清白蛋白≤35 g/L、结石嵌顿、胆总管直径≤1 cm、无鼻胆管引流均为影响三镜联合胆总管切开取石一期缝合术后发生胆漏的危险因素。结论血清白蛋白≤35 g/L、结石嵌顿、胆总管直径≤1 cm、无鼻胆管引流为三镜联合胆总管切开取石一期缝合术后发生胆漏的危险因素,临床可针对具有高危因素的病人进行及早预防和支持治疗,降低术后胆漏发生率。

Objective To explore the risk factors of bile leakage in patients with common bile duct stones(CBDS)after choledochoscope and duodenoscope combined with Laparoscopic choledochal exploration of stone calculi for primary suture.Methods A total of 176 patients with CBDS undergoing triple endoscopy combined with choledocholithotomy for primary suture were enrolled as the research objects between January 2019 to October 2022.The clinical data of patients and occurrence of postoperative bile leakage were statistically analyzed.The risk factors of bile leakage were analyzed by multivariate regression analysis.Results In the 176 patients with CBDS undergoing triple endoscopy combined with choledocholithotomy for primary suture,there were 29 cases(16.48%)with bile leakage.Multivariate Logistic analysis showed that serum albumin≤35g/L,stone incarceration,diameter of common bile duct≤1cm and no nasobiliary drainage were risk factors of bile leakage.Conclusion Serum albumin≤35g/L,stone incarceration,diameter of common bile duct≤1cm and no nasobiliary drainage are risk factors of bile leakage after triple endoscopy combined with choledocholithotomy for primary suture.Clinically,early prevention and supportive treatment can be conducted for patients with high-risk factors to reduce the incidence of postoperative bile leakage.