肝内胆管结石行腹腔镜肝叶切除术后胸腔积液风险因素分析及处理对策

Risk factors and treatment countermeasures of pleural effusion in intrahepatic bile duct stones after laparoscopic hepatectomy

目的探究肝内胆管结石行腹腔镜肝叶切除术后胸腔积液风险因素并制定相关处理对策。方法纳入100例腹腔镜肝叶切除术治疗的肝内胆管结石患者,根据术后3个月内胸腔积液出现情况将患者分为胸腔积液组(n=48)及对照组(n=52),比较两组患者的临床资料,分析影响患者出现胸腔积液的危险因素及各因素对胸腔积液发生的预测价值。结果胸腔积液组术中出血量>400 ml、低蛋白血症、术后输血量≥200 ml的人数比例高于对照组(χ^(2)分别=7.72、8.87、4.54,P均<0.05);进一步多因素分析显示,术中出血量>400 ml、低蛋白血症、术后输血量≥200 ml是肝内胆管结石患者行腹腔镜肝叶切除术后出现胸腔积液的危险因素(OR分别=1.83、2.37、1.63,P均<0.05);各危险因素联合预测患者术后出现胸腔积液的曲线下面积(AUC)大于术中出血量、低蛋白血症、术后输血量单独检测(Z分别=4.20、4.16、3.48,P均<0.05)。结论术中出血量及术后输血量大、低蛋白血症是影响腹腔镜肝叶切除术患者出现胸腔积液的危险因素,临床上需注意低蛋白血症的预防。

Objective To explore the risk factors of pleural effusion in intrahepatic bile duct stones after laparoscopic hepatectomy,and to formulate the treatment strategies.Methods A total of 100 patients with intrahepatic bile duct stones undergoing laparoscopic hepatectomy were enrolled and divided into effusion group(n=48)and control group(n=52)according to whether occurring pleural effusion or not within 3 months after surgery.The clinical data in the two groups were compared.The risk factors of pleural effusion and their predictive value for pleural effusion were analyzed.Results The proportions of cases with intraoperative blood loss>400 ml,hypoalbuminemia and postoperative transfusion volume≥200 ml in effusion group were higher than those in control group(χ^(2)=7.72,8.87,4.54,P<0.05).Multivariate analysis showed that intraoperative blood loss>400 ml,hypoalbuminemia and postoperative transfusion volume≥200 ml were risk factors of pleural effusion in patients with intrahepatic bile duct stones after laparoscopic hepatectomy(OR=1.83,2.37,1.63,P<0.05).AUC of combined detection with different risk factors for predicting pleural effusion was greater than that of single index(Z=4.20,4.16,3.48,P<0.05).Conclusion Much intraoperative blood loss and postoperative transfusion volume,and hypoalbuminemia are risk factors of pleural effusion in patients after laparoscopic hepatectomy.It should be paid attention to the prevention of hypoalbuminemia.