小儿先天性胆总管囊肿腹腔镜手术治疗后并发胆管炎的危险因素分析

Risk factors for postoperative cholangitis in children undergoing laparoscopic choledochal cysts surgery

目的探讨小儿先天性胆总管囊肿腹腔镜手术治疗后并发胆管炎的危险因素。方法纳入湖南省儿童医院2018年6月至2022年6月明确诊断并已行腹腔镜手术治疗的小儿先天性胆总管囊肿85例,根据术后有无并发胆管炎分为并发组(n=14)及未并发组(n=71),对比两组患儿临床特征。logistic回归分析小儿先天性胆总管囊肿腹腔镜手术治疗后并发胆管炎的危险因素。结果并发组贫血、合并胆道结石、囊肿直径>5 cm、术前白蛋白≤30 g/L、术中出血量>60 mL、术前总胆红素>1.7μmol/L分别为9例、11例、10例、10例、11例、12例,明显高于未并发组的28.17%(20/71)、40.85%(29/71)、30.99%(22/71)、42.25%(30/71)、45.07%(37/71)、35.21%(25/71)(P<0.05)。多因素logistic回归分析证实,贫血、有合并胆道结石、囊肿直径>5 cm、术前白蛋白≤30 g/L、术中出血量>60 mL、术前总胆红素>1.7μmol/L均是小儿先天性胆总管囊肿腹腔镜手术治疗后并发胆管炎的危险因素(P<0.05)。结论小儿先天性胆总管囊肿腹腔镜手术治疗后胆管炎的发生与贫血、囊肿直径、术中出血量、合并胆道结石、术前白蛋白、术前总胆红素有明显关系。

Objective To explore the risk factors associated with the development of cholangitis following laparoscopic surgery for pediatric congenital choledochal cysts,and to provide preventive a framework to help reduce the incidence of postoperative cholangitis.Methods Eighty-five children diagnosed with congenital choledochal cysts who underwent laparoscopic surgery at our hospital from June 2018 to June 2022 were included in the study.Based on the occurrence of postoperative cholangitis,participants were divided into two groups:a concurrent group(n=14)and a non-concurrent group(n=71).Differences in clinical characteristics between the two groups were compared.Univariate and multivariate Logistic regression analyses were used to evaluate the risk factors for cholangitis following laparoscopic surgery for congenital choledochal cysts in children.Results In the concurrent group,the proportions of anemia,biliary calculi,cyst diameter>5cm,preoperative albumin≤30g/L,intraoperative bleeding>60ml,and preoperative total bilirubin>1.7μmol/L was 64.28%,78.57%,71.43%,71.43%,78.57%,85.71%respectively,which were significantly higher than those in the non-concurrent group(28.17%,40.85%,30.99%,42.25%,45.07%,35.21%,respectively)(all P<0.05);Multivariate logistic regression analysis confirmed that anemia,biliary calculi,cyst diameter>5cm,preoperative albumin≤30g/L,intraoperative bleeding>60ml,and preoperative total bilirubin>1.7μmol/L were risk factors for cholangitis after laparoscopic surgery for congenital choledochal cyst in children(P<0.05).Conclusion The incidence of cholangitis following laparoscopic surgery for congenital choledochal cyst in children is significantly associated with factors such as anemia,cyst diameter,intraoperative bleeding,presence of biliary calculus,preoperative albumin levels,and preoperative total bilirubin levels.