良性胆囊疾病行腹腔镜胆囊切除术后发生腹腔出血的危险因素Logistic回归分析

Logistic regression analysis of risk factors of abdominal bleeding after laparoscopic cholecystectomy for benign gallbladder disease

目的:探讨良性胆囊疾病行腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)后发生腹腔出血的危险因素。方法:回顾性选取兰考县中医院2020年2月至2022年2月期间收治的行LC术的良性胆囊疾病患者359例,根据LC术后是否发生腹腔出血,分为出血组和未出血组,单因素和多因素Logistic回归分析探讨LC术后发生腹腔出血的危险因素。结果:腹腔出血发生率为4.74%(17/359);单因素分析显示,出血组和未出血组胆囊壁的厚度、解剖结构发生变异、胆囊萎缩状况、Calot三角黏连状况、Calot三角电灼状况、手术时机比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,胆囊壁的厚度≥5 mm、解剖结构发生变异、Calot三角黏连、Calot三角电灼、急诊手术为良性胆囊疾病LC术后发生腹腔出血的独立危险因素(P<0.05)。结论:良性胆囊疾病患者LC术后发生腹腔出血的独立危险因素有:胆囊壁的厚度≥5 mm、解剖结构发生变异、Calot三角黏连、Calot三角电灼、急诊手术,临床可针对性制定预防措施,以降低腹腔出血的发生率。

Objective:To explore the risk factors of abdominal bleeding after laparoscopic cholecystectomy(LC)for benign gallbladder disease.Methods:Three hundred and fifty-nine patients with benign gallbladder disease who underwent LC in Lankao County Hospital of Traditional Chinese Medicine from February 2020 to February 2022 were selected retrospectively.They were divided into bleeding group and non-bleeding group according to whether there was abdominal bleeding after LC.The risk factors of abdominal bleeding after LC were analyzed by univariate and multivariate logistic regression analysis.Results:The incidence of abdominal bleeding was 4.74%(17/359);univariate analysis showed that there were statistically significant differences in gallbladder wall thickness,variation of anatomical structure,gallbladder atrophy,adhesion of Calot triangle,cauterization of Calot triangle and operation time between the bleeding group and the non-bleeding group(P<0.05);multivariate logistic regression analysis showed that the thickness of gallbladder wall≥5 mm,the variation of anatomical structure,the adhesion of Calot triangle,the cauterization of Calot triangle,and emergency surgery were independent risk factors for abdominal bleeding after LC for benign gallbladder disease(P<0.05).Conclusion:Independent risk factors of abdominal bleeding after LC for benign gallbladder disease include the thickness of gallbladder wall≥5 mm,variation of anatomical structure,adhesion of Calot triangle,cauterization of Calot triangle and emergency operation.Clinical preventive measures can be formulated to reduce the incidence of abdominal bleeding.