基于倾向性评分匹配分析腹腔镜胆囊切除术后发生胆漏的危险因素

Risk factors of biliary leakage after laparoscopic cholecystectomy based on propensity score matching

目的:探索腹腔镜胆囊切除术(LC)后发生胆漏的危险因素。方法:回顾性收集2013年1月至2022年11月收治的1637例LC患者的临床资料,根据LC术后胆漏发生情况分为发生组与未发生组。基于倾向性评分匹配法对两组进行1∶1匹配。匹配后采用单因素、多因素Logistic回归分析患者LC术后发生胆漏的危险因素。结果:1637例行LC治疗的患者中64例术后发生胆漏,发生率为3.91%。倾向性评分匹配法共匹配出61对(122例)患者。匹配后发生组合并糖尿病、胆囊颈部结石、胆总管直径≤3 mm、Calot三角粘连、胆囊与周围粘连、解剖变异、胆囊三角电灼、胆囊壁厚度≥5 mm的占比均高于未发生组(P<0.05),术者手术经验≥5年、放置引流管的比例低于未发生组(P<0.05),经Logistic回归分析,胆囊颈部结石、胆总管直径≤3 mm、Calot三角粘连、胆囊与周围粘连、解剖变异、胆囊三角电灼、胆囊壁厚度≥5 mm是LC术后发生胆漏的独立危险因素(P<0.05),术者手术经验≥5年是保护因素(P<0.05)。结论:胆囊颈部结石、胆总管直径、Calot三角粘连、胆囊与周围粘连、解剖变异、胆囊三角电灼、胆囊壁厚度、术者手术经验均是LC术后发生胆漏的影响因素,临床需加大对以上因素的关注。

Objective:To explore the risk factors of biliary leakage after laparoscopic cholecystectomy(LC).Methods:The clinical data of 1637 LC patients treated from Jan.2013 to Nov.2022 were retrospectively collected.Patients were divided into the o ccurrence group and the non-occurrence group according to whether biliary leakage occurred or not after LC.Based on the propensity score matching,1∶1 matching was conducted between the occurrence group and the non-occurrence group.The risk factors of biliary leakage after LC were analyzed by single factor and multi-factor logistic regression after matching.Results:Among 1637 patients treated with LC,64 patients were complicated with biliary leakage after operation,with an incidence of 3.91%.61 pairs(122 cases)of patients were matched by propensity score matching.After matching,the proportions of patients with diabetes,gallbladder neck stones,common bile duct diameter≤3 mm,Calot triangle adhesion,adhesion between gallbladder and surrounding,anatomical variation,gallbladder t riangle electrocautery and gallbladder wall thickness≥5 mm in the occurrence group were higher than those in the non-occurrence group(P<0.05),while the proportions of patients with operation experience of doctors≥5 years and drainage tube placement were lower than those in the non-occurrence group(P<0.05).Logistic regression analysis showed that calculus in the neck of the gallbla-dder,diameter of the common bile duct≤3 mm,Calot triangle adhesion,gallbladder adhesion with its surroundings,anatomical variation,electrocautery of the gallbladder triangle and thickness of the gallbladder wall≥5 mm were independent risk factors for biliary leakage after LC(P<0.05),while operation experience of doctors≥5 years was protective factor(P<0.05).Conclusions:Calculus in the neck of gallbladder,diameter of common bile duct,adhesion of Calot triangle,adhesion of gallbladder and its surroundings,anatomical variation,electrocautery of gallbladder triangle,thickness of gallbladder wall and doctor's operation experience are all the influencing factors of biliary leakage after LC,and more attention should be paid to these factors in clinical practice.